Izumi Kenta, Hisata Yoichi, Hazama Shiro
Division of Cardiovascular Surgery, Sasebo City General Hospital, Nagasaki, Japan.
Ann Thorac Cardiovasc Surg. 2009 Oct;15(5):350-3.
The patient was a 58-year-old male. He consulted our hospital because of weight loss and fever. Computed tomography (CT) revealed renal infarction. Nine days after admission, CT showed hemorrhagic cerebral infarction in the right frontal lobe. A blood culture revealed streptococcus oralis, and echocardiography revealed vegetation in the mitral and aortic valves, suggesting infective endocarditis (IE). Fever (39 degrees C or higher) was noted 23 days after admission. A blood culture revealed Trichosporon asahii (T. asahii), suggesting T. asahii fungemia. An intravenous drip of fluconazole at 400 mg/day was initiated, and two-valve replacement was performed 34 days after admission. Following surgery, the patient became negative for beta-D glucan and was discharged 85 days after admission. We report the present case of IE complicated by T. asahii fungemia, which is rare in patients other than malignant blood disease or tumor patients, showing a poor prognosis in which survival was achieved by surgery.
该患者为一名58岁男性。他因体重减轻和发热前来我院就诊。计算机断层扫描（CT）显示肾梗死。入院九天后，CT显示右额叶出血性脑梗死。血培养显示口腔链球菌，超声心动图显示二尖瓣和主动脉瓣有赘生物，提示感染性心内膜炎（IE）。入院23天后出现发热（39摄氏度或更高）。血培养显示浅白隐球菌（T. asahii），提示浅白隐球菌菌血症。开始每日静脉滴注400毫克氟康唑，并在入院34天后进行双瓣膜置换术。术后，患者β-D葡聚糖转阴，入院85天后出院。我们报告了这例并发浅白隐球菌菌血症的IE病例，除恶性血液病或肿瘤患者外，该病例在其他患者中较为罕见，预后较差，通过手术得以存活。
