Sides E H, Benson J D, Padhye A A
Rex Hospital, Raleigh, North Carolina.
J Med Vet Mycol. 1991;29(5):317-22.
A 60-year-old man with a 9-year history of malignant lymphoma developed an initial pulmonary infection with Nocardia asteroides which later disseminated to the central nervous system with multiple brain abscesses. He was treated successfully with intravenous trimethoprim-sulfamethoxazole for 6 weeks. A follow-up computed tomography (CT) scan showed complete resolution of the abscesses. Two years later, he returned to the hospital with a 2-week history of confusion, loss of concentration, ataxia, and leaning to the left. A CT scan revealed an enhancing multiloculated complex right frontal lesion. Craniotomy revealed a large right frontal lobe abscess, which was totally resected. Histopathologic examination of the resected tissue revealed multiple, lightly pigmented, septate, branched hyphal elements typical of phaeohyphomycosis. The fungal isolate cultured from the tissue was a dematiaceous, thermotolerant fungus that was identified as Ochroconis gallopavum. Despite treatment with amphotericin B, flucytosine and fluconazole, the patient gradually deteriorated and died. This case represents the third fatal infection, the second from the southeastern United States, due to O. gallopavum.
一名患有恶性淋巴瘤9年的60岁男性最初发生了星形诺卡菌肺部感染，随后感染播散至中枢神经系统，形成多个脑脓肿。他接受了静脉注射甲氧苄啶 - 磺胺甲恶唑治疗6周，治疗成功，脓肿完全消退。两年后，他因2周的意识模糊、注意力不集中、共济失调和向左倾斜再次入院。CT扫描显示右侧额叶有一个强化的多房性复杂病变。开颅手术发现一个巨大的右侧额叶脓肿，并将其完全切除。切除组织的组织病理学检查显示多个轻度色素沉着、有隔、分支的菌丝成分，这是暗色丝孢霉病的典型表现。从组织中培养出的真菌分离株是一种暗色、耐热真菌，鉴定为鸡雏赭曲霉。尽管使用了两性霉素B、氟胞嘧啶和氟康唑治疗，患者仍逐渐恶化并死亡。该病例是由鸡雏赭曲霉引起的第三例致命感染，也是美国东南部的第二例。
