Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
Hospital Couto Maia, Secretaria de Saúde do Estado da Bahia, Salvador, BA, Brasil.
Rev Soc Bras Med Trop. 2014 Mar-Apr;47(2):254-6. doi: 10.1590/0037-8682-0215-2013.
Cryptococcus spp. cerebral abscesses are uncommon in immunocompetent subjects. The recommended induction treatment is the administration of amphotericin B plus flucytosine combined with resection for lesions ≥3cm. In this paper, we describe an HIV-negative woman diagnosed with a large cryptococcoma in the immediate postpartum period. The lesion was not resected, and due to amphotericin B intolerance, she received an extended course of fluconazole monotherapy. There was no disease recurrence during the 4 years of follow-up. The abrupt onset of her symptoms following delivery suggests that she developed a postpartum immune reconstitution syndrome. This case also demonstrates that in specific situations fluconazole monotherapy can be attempted in immunocompetent patients with cryptococcoma.
新型隐球菌性脑脓肿在免疫功能正常的患者中较为少见。推荐的诱导治疗方案为两性霉素 B 联合氟胞嘧啶治疗，对于直径≥3cm 的病灶需进行手术切除。本文报道了 1 例 HIV 阴性的产妇，在产后即刻诊断为巨大新型隐球菌肿。由于病灶未予切除，且患者对两性霉素 B 不耐受，故给予氟康唑单药治疗。在 4 年的随访中未出现疾病复发。患者在产后出现症状提示其发生了产后免疫重建综合征。该病例还表明，在某些特定情况下，氟康唑单药治疗可用于治疗新型隐球菌肿的免疫功能正常患者。
