Hur Jong Hee, Kim Jang-Hee, Park Seoung Woo, Cho Kyung Gi
Department of Neurosurgery, School of Medicine, Ajou University, Suwon, Korea.
Department of Pathology, School of Medicine, Ajou University, Suwon, Korea.
J Korean Neurosurg Soc. 2015 Jan;57(1):50-3. doi: 10.3340/jkns.2015.57.1.50. Epub 2015 Jan 31.
Usually fungal infections caused by opportunistic and pathogenic fungi had been an important cause of morbidity and mortality among immunocompromised patients. However clinical data and investigations for immunocompetent pathogenic fungal infections had been rare and neglected into clinical studies. Especially Cryptococcal brainstem abscess cases mimicking brain tumors were also much more rare. So we report this unusual case. This 47-year-old man presented with a history of progressively worsening headache and nausea for 1 month and several days of vomituritions before admission. Neurological and laboratory examinations performed demonstrated no abnormal findings. Previously he was healthy and did not have any significant medical illnesses. A CT and MRI scan revealed enhancing 1.8×1.7×2.0 cm mass lesion in the left pons having central necrosis and peripheral edema compressing the fourth ventricle. And also positron emission tomogram scan demonstrated a hot uptake of fluoro-deoxy-glucose on the brainstem lesion without any evidences of systemic metastasis. Gross total mass resection was achieved with lateral suboccipital approach with neuronavigation system. Postoperatively he recovered without any neurological deficits. Pathologic report confirmed Cryptococcus neoformans and he was successively treated with antifungal medications. This is a previously unreported rare case of brainstem Cryptococcal abscess mimicking brain tumors in immunocompetent host without having any apparent typical meningeal symptoms and signs with resultant good neurosurgical recovery.
通常，由机会性真菌和致病性真菌引起的真菌感染一直是免疫功能低下患者发病和死亡的重要原因。然而，关于免疫功能正常者致病性真菌感染的临床数据和研究却很罕见，且被临床研究忽视。特别是模仿脑肿瘤的隐球菌脑干脓肿病例也更为罕见。因此，我们报告这一罕见病例。该47岁男性在入院前有1个月逐渐加重的头痛和恶心病史，以及数天的呕吐。进行的神经学和实验室检查未发现异常。他既往健康，没有任何重大疾病。CT和MRI扫描显示左脑桥有一个1.8×1.7×2.0 cm的强化肿块病变，有中央坏死和周围水肿，压迫第四脑室。正电子发射断层扫描显示脑干病变处氟脱氧葡萄糖摄取增加，无任何全身转移迹象。采用枕下外侧入路并借助神经导航系统实现了肿瘤全切。术后他恢复良好，无任何神经功能缺损。病理报告证实为新型隐球菌，随后他接受了抗真菌药物治疗。这是一例此前未报道的罕见病例，在免疫功能正常的宿主中出现模仿脑肿瘤的脑干隐球菌脓肿，没有任何明显的典型脑膜症状和体征，神经外科治疗效果良好。
