Martinez-Longoria Cesar Adrián, Rubio-Perez Nadina Eugenia, Rios-Solis Josue Emmanuel, Garcia-Rodriguez Fernando
Department of Pediatrics, Hospital Universitario "Dr. José E. González", Av. Madero y Av. Gonzalitos S/N, Col. Mitras Centro, Monterrey, Mexico.
Department of Pediatrics, Hospital Universitario "Dr. José E. González", Av. Madero y Av. Gonzalitos S/N, Col. Mitras Centro, Monterrey, Mexico.
Int J Infect Dis. 2015 Apr;33:106-8. doi: 10.1016/j.ijid.2014.05.033. Epub 2014 Oct 24.
The incidences of infection with Mycobacterium tuberculosis and Cryptococcus neoformans in immunocompromised patients have increased, but there are few documented cases of their coexistence. We present the case of a 9-year-old female with systemic lupus erythematosus (SLE), treated with prednisone and cyclophosphamide, who was admitted to the emergency department with a 2-week history of fever, headache, malaise, fatigue, and diplopia 3 years after diagnosis. Physical examination showed limitation of abduction of the right eye, Kernig and Brudzinski signs, and hyporeflexia. Magnetic resonance imaging showed hyperdense lesions located in the caudate nucleus, and lumbar puncture showed pleocytosis, a low glucose level, and increased protein level. Cerebrospinal fluid culture identified C. neoformans and PCR detect M. tuberculosis. Treatment was started with isoniazid, rifampin, pyrazinamide, ethambutol, and amphotericin B. We found two similar reports in adults, but no data were found for either pediatric or SLE patients.
免疫功能低下患者中结核分枝杆菌和新型隐球菌感染的发生率有所上升，但二者共存的病例记录很少。我们报告一例9岁女性系统性红斑狼疮（SLE）患者，接受泼尼松和环磷酰胺治疗，诊断3年后因发热、头痛、不适、疲劳和复视2周入住急诊科。体格检查显示右眼外展受限、克尼格征和布鲁津斯基征阳性以及反射减弱。磁共振成像显示尾状核有高密度病变，腰椎穿刺显示细胞增多、葡萄糖水平降低和蛋白质水平升高。脑脊液培养鉴定出新型隐球菌，聚合酶链反应检测到结核分枝杆菌。开始使用异烟肼、利福平、吡嗪酰胺、乙胺丁醇和两性霉素B进行治疗。我们在成人中发现了两份类似报告，但未找到儿童或SLE患者的相关数据。
