Department of Medical Microbiology and Virology, National Health Laboratory Service (NHLS)/University of the Free State, Bloemfontein, Republic of South Africa.
Department of Anatomical Pathology, NHLS/University of the Free State, Bloemfontein, Republic of South Africa.
J Med Microbiol. 2011 Oct;60(Pt 10):1534-1538. doi: 10.1099/jmm.0.031146-0. Epub 2011 May 19.
Infection of the central nervous system (CNS) is a rare but devastating complication of invasive aspergillosis. We report a case of invasive aspergillosis with spinal involvement in a human immunodeficiency virus (HIV)-infected patient without neutropenia. A 42-year-old, antiretroviral-naïve, HIV-infected man presented with progressive weakness in the lower limbs and urinary and faecal incontinence for 2 weeks. The patient had been prescribed broad-spectrum antibiotics and prednisone. He had upper motor neuron signs and a sensory level at T1, with accompanying neck stiffness on flexion. Magnetic resonance imaging revealed diffuse abnormal signals of the vertebral bodies in the lower cervical and thoracic areas, with cord compression in the C2 and C3 region and signal distortions of the T2 and T3 vertebral bodies. Chest X-ray and computerized tomography demonstrated post-tuberculous apical cavities with suspected fungal colonization. Histopathology of an extradural spinal lesion at T1/T2 suggested invasive aspergillosis. The patient was started on fluconazole in response to the histopathological evidence of Aspergillus infection, but died within 3 weeks. Post-mortem analysis of the biopsy sample by PCR identified the infectious agent as Aspergillus fumigatus. Atypically, his CD4(+) T-cell count was 239 cells mm(-3) and he had no evidence of neutropenia. Invasive aspergillosis should be considered as part of the differential diagnosis among HIV-infected patients with non-specific, focal CNS symptoms, even among those without classical risk factors such as neutropenia, and aggressive antifungal therapy should be instituted as early as possible.
中枢神经系统（CNS）感染是侵袭性曲霉菌病的一种罕见但严重的并发症。我们报告了一例 HIV 感染患者发生侵袭性曲霉菌病合并脊髓受累的病例，该患者无中性粒细胞减少症。一名 42 岁、未接受过抗逆转录病毒治疗的 HIV 感染男性，因下肢进行性无力和尿便失禁 2 周就诊。患者曾接受广谱抗生素和泼尼松治疗。他有上运动神经元体征和 T1 感觉平面，伴有颈部屈曲时的颈部僵硬。磁共振成像显示下颈段和胸段椎体弥漫性异常信号，C2 和 C3 区域脊髓受压，T2 和 T3 椎体信号扭曲。胸部 X 线和计算机断层扫描显示肺结核尖后空洞，疑似真菌感染。T1/T2 硬膜外脊柱病变的组织病理学提示侵袭性曲霉菌病。鉴于曲霉菌感染的组织病理学证据，患者开始使用氟康唑治疗，但在 3 周内死亡。对活检样本进行聚合酶链反应（PCR）的死后分析确定病原体为烟曲霉菌。异常的是，他的 CD4(+) T 细胞计数为 239 个细胞/mm(-3)，且无中性粒细胞减少症证据。侵袭性曲霉菌病应作为 HIV 感染患者出现非特异性、局灶性 CNS 症状时鉴别诊断的一部分，即使在没有中性粒细胞减少症等典型危险因素的患者中也是如此，应尽早开始积极的抗真菌治疗。
