Yampolsky Claudio, Corti Marcelo, Negroni Ricardo
Department of Infectious Diseases, F.J. Muñiz Hospital, Buenos Aires, Argentina.
Rev Iberoam Micol. 2010 Mar 31;27(1):6-9. doi: 10.1016/j.riam.2009.12.001. Epub 2010 Mar 1.
Intracranial fungal masses are uncommon diseases, but their incidence is increasing, most often due to the prolonged survival of patients with different immunodeficiencies. The management of patients with intracranial fungal masses included stereotactic biopsy for diagnosis, partial or radical surgery excision and prolonged antifungal therapy.
We report the case of a 51-year-old diabetic man with a history of psoas abscess due to Candida albicans 1 year before the onset of neurological symptoms, including headache and generalized tonoclonic seizures.
Magnetic resonance imaging showed a single lesion located in the right parietal lobe with mass effect, surrounding edema and enhancement after injection of gadolinium. The material was purulent.
Direct microscopic examination showed hyaline, branched and septate hyphae compatible with fungal elements.
Fungal infections, especially due to Candida species, should be considered in diabetic patients with parenchymal brain abscesses. Radical excision followed by prolonged antifungal therapy based on fluconazole or amphotericin B is necessary to improve the prognosis of this type of patients.
颅内真菌肿块是罕见疾病，但其发病率正在上升，这主要是由于不同免疫缺陷患者的生存期延长所致。颅内真菌肿块患者的治疗包括用于诊断的立体定向活检、部分或根治性手术切除以及长期抗真菌治疗。
我们报告一例51岁糖尿病男性病例，在出现包括头痛和全身性强直阵挛性癫痫发作等神经症状前1年，有白色念珠菌引起的腰大肌脓肿病史。
磁共振成像显示位于右顶叶的单个病灶，有占位效应、周围水肿以及注射钆后强化。材料为脓性。
直接显微镜检查显示与真菌成分相符的透明、分支且有隔膜的菌丝。
对于患有实质性脑脓肿的糖尿病患者，应考虑真菌感染，尤其是念珠菌属引起的感染。根治性切除后基于氟康唑或两性霉素B进行长期抗真菌治疗对于改善这类患者的预后是必要的。
