Horiuchi Kazuhiro, Yamada Moemi, Shirai Shinichi, Takahashi Ikuko, Kano Takahiro, Kaneko Yukihiro, Akizawa Kouji, Umeyama Takashi, Miyazaki Yoshitsugu, Yabe Ichiro, Sasaki Hidenao
Department of Neurology, Hokkaido University Graduate School of Medicine.
Rinsho Shinkeigaku. 2012;52(3):166-71. doi: 10.5692/clinicalneurol.52.166.
We report the case of a 34-year-old woman with cerebral and pulmonary cryptococcosis. After surgery for uterine cervical cancer, chest CT scan indicated a solitary tumor. Cryptococcosis was detected by transbronchial lung biopsy, and brain MRI showed multiple tumors. We diagnosed the patient with cerebral and pulmonary cryptococcosis. Oral and intravenous antifungal treatments were not effective, and a disturbance of consciousness appeared. We began intraventricular antifungal treatment, and the symptoms improved, with a reduction in the size of multiple lesions. However, the size of the brain lesions increased, and we diagnosed late deterioration of cryptococcosis and corticosteroid response. Because of the refractory clinical course, we examined the Cryptococcus strains from the surgical resected pulmonary lesion and identified Cryptococcus gattii(VG I type). C. gattii occurs predominantly in apparently healthy hosts. An intracranial C. gattii infection is associated with neurological complications and delayed therapeutic response. If cerebral cryptococcosis responds slowly and relatively poorly to antifungal therapy, C. gattii should be considered. Aggressive therapy, including intraventricular therapy and corticosteroids therapy for cryptococcoma, is required.
我们报告了一例34岁患有脑和肺隐球菌病的女性病例。子宫颈癌手术后，胸部CT扫描显示有一个孤立性肿瘤。经支气管肺活检检测出隐球菌病，脑部MRI显示有多个肿瘤。我们诊断该患者患有脑和肺隐球菌病。口服和静脉注射抗真菌治疗均无效，且出现了意识障碍。我们开始进行脑室内抗真菌治疗，症状有所改善，多个病灶的大小也有所减小。然而，脑部病灶的大小又增大了，我们诊断为隐球菌病晚期恶化及皮质类固醇反应。由于临床病程难治，我们对手术切除的肺部病灶中的隐球菌菌株进行了检测，鉴定为加氏隐球菌（VG I型）。加氏隐球菌主要发生在看似健康的宿主中。颅内加氏隐球菌感染与神经并发症及治疗反应延迟有关。如果脑隐球菌病对抗真菌治疗反应缓慢且相对较差，应考虑加氏隐球菌感染。对于隐球菌瘤，需要采取积极的治疗措施，包括脑室内治疗和皮质类固醇治疗。
