Neurosurgery Service, Hospital Egas Moniz - Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal.
Clin Drug Investig. 2013 Feb;33 Suppl 1:S27-31. doi: 10.1007/s40261-012-0016-2.
Cerebral phaeohyphomycosis is an infrequent infectious condition associated with a high mortality rate. The authors describe a very rare case that occurred in an immunocompetent 18-year-old man who developed severe meningoencephalitis and arachnoiditis caused by Alternaria alternata, which were diagnosed in the context of difficult-to-treat hydrocephalus. Etiological diagnosis was made based on fungal culture and histopathologic examination. Empirical treatment consisted of an early aggressive antifungal combination therapy consisting of intravenous liposomal amphotericin B (5 mg/kg per day) and voriconazole (4 mg/kg every 12 h), which initially induced a favorable response. Following the fungus identification, the choice for the combination of posaconazole (400 mg every 12 h) plus flucytosine (4000 mg/day) proved to be effective in the suppression of the signs and symptoms of this uncommon cerebral mycosis. At a 12-month follow-up visit no recurrence had occurred and posaconazole was then stopped.
脑暗色丝孢霉病是一种罕见的感染性疾病，死亡率很高。作者描述了一例非常罕见的病例，发生在一名免疫功能正常的 18 岁男性，他因粗球腔菌引起的严重脑膜脑炎和蛛网膜炎，在难以治疗的脑积水的背景下被诊断出来。病因诊断基于真菌培养和组织病理学检查。经验性治疗包括早期积极的抗真菌联合治疗，即静脉注射脂质体两性霉素 B（5 mg/kg/天）和伏立康唑（4 mg/kg，每 12 小时一次），最初诱导了良好的反应。在鉴定真菌后，选择泊沙康唑（400 mg，每 12 小时一次）加氟胞嘧啶（4000 mg/天）的联合治疗方案有效地抑制了这种罕见的脑真菌感染的症状和体征。在 12 个月的随访中，没有复发，然后停止使用泊沙康唑。
