Inada Taku, Imamura Hirotoshi, Kawamoto Michi, Sekiya Hiroaki, Imai Yukihiro, Tani Shoichi, Adachi Hidemitsu, Ishikawa Tatsuya, Mineharu Yohei, Asai Katsunori, Ikeda Hiroyuki, Ogura Takenori, Shibata Teishiki, Beppu Mikiya, Agawa Yuji, Shimizu Kanpei, Sakai Nobuyuki, Kikuchi Haruhiko
Department of Neurosurgery, Kobe City Medical Center General Hospital.
No Shinkei Geka. 2014 Feb;42(2):123-7.
Cryptococcosis is a fungal infection, which mainly invades the lungs and central nervous system. In Japan, most cases of cryptococcosis are caused by Cryptococcus neoformans(C. neoformans). Until now, only three cases which the infectious agent was Cryptococcus neoformans var. gattii(C. gattii)have been reported. As compared with cryptococcosis caused by C. neoformans, which is often observed in immunocompromised hosts, cryptococcosis caused by C. gattii occurs predominantly in immunocompetent hosts and is resistant to antifungal drugs. Here, we report a case of refractory cerebral cryptococcoma that was successfully treated by surgical resection of the lesions. A 33-year-old man with no medical history complained of headache, hearing disturbance, and irritability. Pulmonary CT showed a nodular lesion in the left lung. Cerebrospinal fluid examination with Indian ink indicated cryptococcal meningitis, and PCR confirmed infection with C. gattii. C. gattii is usually seen in the tropics and subtropics. Since this patient imported trees and soils from abroad to feed stag beetles, parasite or fungal infection was, as such, suspected. Although he received 2 years of intravenous and intraventricular antifungal treatment, brain cryptococcomas were formed and gradually increased. Because of the refractory clinical course, the patient underwent surgical resection of the cerebral lesions. With continuation of antifungal drugs for 6 months after the surgeries, Cryptococcus could not be cultured from cerebrospinal fluid, and no lesions were seen on MR images. If cerebral cryptococcosis responds poorly to antifungal agents, surgical treatment of the cerebral lesion should be considered.
隐球菌病是一种真菌感染，主要侵袭肺部和中枢神经系统。在日本，大多数隐球菌病病例是由新型隐球菌引起的。到目前为止，仅报告了3例感染病原体为格特隐球菌变种的病例。与常在免疫功能低下宿主中出现的新型隐球菌引起的隐球菌病相比，格特隐球菌引起的隐球菌病主要发生在免疫功能正常的宿主中，并且对抗真菌药物耐药。在此，我们报告1例难治性脑隐球菌瘤，通过手术切除病灶成功治愈。一名无病史的33岁男性主诉头痛、听力障碍和易怒。肺部CT显示左肺有一个结节性病变。脑脊液墨汁染色检查提示隐球菌性脑膜炎，PCR证实感染格特隐球菌。格特隐球菌通常见于热带和亚热带地区。由于该患者从国外进口树木和土壤来饲养锹甲，因此怀疑有寄生虫或真菌感染。尽管他接受了2年的静脉和脑室内抗真菌治疗，但仍形成了脑隐球菌瘤并逐渐增大。由于临床病程难治，该患者接受了脑病灶的手术切除。术后继续使用抗真菌药物6个月，脑脊液中未培养出隐球菌，磁共振成像未发现病灶。如果脑隐球菌病对抗真菌药物反应不佳，应考虑对脑病灶进行手术治疗。
