Division of Infectious Diseases, Brigham and Women's Hospital, 75 Francis Street, PBB-A4, Boston, MA 02115, USA.
Med Mycol. 2010 Aug;48(5):769-74. doi: 10.3109/13693780903471081.
We report a case of Fonsecaea monophora cerebral phaeohyphomycosis successfully treated with surgical excision and voriconazole monotherapy in a patient receiving maintenance immunosuppression therapy for 8 years after cadaveric renal transplantation. She presented with a severe frontal headache in the absence of any constitutional or neurologic symptoms. Brain magnetic resonance imaging showed an irregular 3.1 x 3.4 cm ring-enhancing lesion in her left frontal lobe. The patient underwent craniotomy and resection of her mass, with intraoperative spillage of some of her abscess contents into her lateral ventricle. Histopathology of her resected mass showed necrotic fragments of brain parenchyma with granulomatous inflammation and numerous pigmented fungal forms. A mold, recovered from cultures inoculated with portions of her brain resection specimen, was later definitively identified as Fonsecaea monophora. Initial serum (1-->3) beta-D-glucan (BG) levels exceeded 500 pg/ml. The patient received voriconazole, which she tolerated well, without recurrent headaches or abscess formation noted on serial brain imaging. Her BG declined to <31 pg/ml one year following her abscess resection. She discontinued antifungal therapy after an 18-month treatment course, and has remained free of any clinical or radiographic evidence of recurrent abscess formation three years later.
我们报告了一例在接受尸体肾移植后 8 年维持免疫抑制治疗的患者中，成功地用手术切除和伏立康唑单药治疗的外瓶霉脑性暗色丝孢霉病。她表现为严重的额部头痛，无任何全身或神经症状。脑磁共振成像显示左额叶有一个不规则的 3.1 x 3.4 厘米的环形增强病变。患者接受了开颅手术和肿块切除术，术中一些脓肿内容物溢出到侧脑室。切除肿块的组织病理学显示脑实质坏死碎片，伴有肉芽肿性炎症和许多色素性真菌形态。从部分脑切除标本接种的培养物中分离出的一种霉菌，后来被明确鉴定为外瓶霉。初始血清（1-->3）β-D-葡聚糖（BG）水平超过 500 pg/ml。患者接受了伏立康唑治疗，耐受性良好，在连续脑成像中未发现头痛或脓肿形成复发。她的 BG 在脓肿切除后一年下降到<31 pg/ml。在 18 个月的治疗疗程后，她停止了抗真菌治疗，三年后仍然没有任何临床或影像学证据表明脓肿形成复发。
