Buchta Vladimír, Prášil Petr, Vejsová Marcela, Mottl Roman, Kutová Radka, Drahošová Marcela, Plíšek Stanislav
Department of Clinical Microbiology, Faculty of Medicine and University Hospital, Charles University, Sokolska 581, 500 05, Hradec Kralove, Czech Republic,
Folia Microbiol (Praha). 2014 Nov;59(6):515-21. doi: 10.1007/s12223-014-0328-0. Epub 2014 Jun 20.
Case of 59-year-old male with chronic obstructive pulmonary disease and a number of comorbidities, who has developed meningoencephalitis caused by Cryptococcus neoformans var. grubii with polyarteritis nodosa diagnosed during hospitalization, was presented. Before evidence of meningoencephalitis, the patient was being treated with ketoconazole and low doses of fluconazole (200 mg/day) for alleged candidiasis. The dosage was increased (800 mg/day) following laboratory diagnosis of C. neoformans based on positive latex agglutination test and biochemical identification of encapsulated yeast isolated from the blood and CSF. Later, the yeast identification was confirmed by sequencing analysis. Owing to inadequate clinical response, fluconazole therapy was switched to voriconazole (400 mg/day) and later to intravenous amphotericin B (1.0 mg/kg per day). Despite of a temporary stabilization and improvement, which correlated with decline of cryptococcal antigen titers (from 1:1024 to 1:8), after 6 weeks, the patient's underlying condition deteriorated due to severe pancolitis and serious nosocomial bacterial infections. The patient died of multiorgan failure several days later. Our case demonstrates a possible connection between the development of life-threatening cryptococcosis and an autoimmune vasculitis disease and emphasizes that the outcome of the management of cryptococcal meningoencephalitis is highly dependent on early diagnosis, adequate treatment, including dosage, and last but not least control of underlying disease and risk factors.
报告了一例59岁男性患者，患有慢性阻塞性肺疾病及多种合并症，住院期间发生新型隐球菌格鲁比变种引起的脑膜脑炎，并诊断为结节性多动脉炎。在出现脑膜脑炎迹象之前，该患者因疑似念珠菌病接受酮康唑和低剂量氟康唑（200毫克/天）治疗。基于乳胶凝集试验阳性及从血液和脑脊液中分离出的有荚膜酵母的生化鉴定，实验室诊断为新型隐球菌后，氟康唑剂量增加（800毫克/天）。后来，通过测序分析确认了酵母鉴定结果。由于临床反应不佳，氟康唑治疗改为伏立康唑（400毫克/天），之后又改为静脉注射两性霉素B（1.0毫克/千克/天）。尽管有暂时的病情稳定和改善，这与隐球菌抗原滴度下降（从1:1024降至1:8）相关，但6周后，患者的基础病情因严重全结肠炎和严重医院获得性细菌感染而恶化。患者几天后死于多器官功能衰竭。我们的病例表明，危及生命的隐球菌病的发生与自身免疫性血管炎疾病之间可能存在联系，并强调隐球菌性脑膜脑炎的治疗结果高度依赖于早期诊断、充分治疗（包括剂量），以及最后但同样重要的对基础疾病和危险因素的控制。
