To Christina A, Hsieh Robert W, McClellan James Scott, Howard Walter, Fischbein Nancy J, Brown Janice M Y, Felsher Dean W, Fan Alice C
Department of Internal Medicine, Scripps Clinic/Green Hospital, La Jolla, California, USA.
BMJ Case Rep. 2012 Sep 7;2012:bcr0820114578. doi: 10.1136/bcr.08.2011.4578.
The authors present the first case report of a patient with lymphoma who developed disseminated cryptococcal osteomyelitis and meningitis while being treated with the PEP-C (prednisone, etoposide, procarbazine and cyclophosphamide) chemotherapy regimen. During investigation of fever and new bony lesions, fungal culture from a rib biopsy revealed that the patient had cryptococcal osteomyelitis. Further evaluation demonstrated concurrent cryptococcal meningitis. The patient's disseminated cryptococcal infections completely resolved after a full course of antifungal treatment. Cryptococcal osteomyelitis is itself an extremely rare diagnosis, and the unique presentation with concurrent cryptococcal meningitis in our patient with lymphoma was likely due to his PEP-C treatment. It is well recognised that prolonged intensive chemotherapeutic regimens place patients at risk for atypical infections; yet physicians should recognise that even chronic low-dose therapies can put patients at risk for fungal infections. Physicians should consider fungal infections as part of the infectious investigation of a lymphopaenic patient on PEP-C.
作者报告了首例淋巴瘤患者的病例，该患者在接受PEP-C（泼尼松、依托泊苷、丙卡巴肼和环磷酰胺）化疗方案治疗期间发生了播散性隐球菌性骨髓炎和脑膜炎。在对发热和新出现的骨病变进行调查时，肋骨活检的真菌培养显示该患者患有隐球菌性骨髓炎。进一步评估显示同时存在隐球菌性脑膜炎。经过一个完整疗程的抗真菌治疗后，患者的播散性隐球菌感染完全消退。隐球菌性骨髓炎本身就是一种极其罕见的诊断，而我们这位淋巴瘤患者同时出现隐球菌性脑膜炎的独特表现可能是由于其接受了PEP-C治疗。众所周知，长期强化化疗方案会使患者面临非典型感染的风险；然而，医生应该认识到，即使是慢性低剂量治疗也会使患者面临真菌感染的风险。医生应将真菌感染视为对接受PEP-C治疗的淋巴细胞减少患者进行感染调查的一部分。
