Okazaki Tomoko, Shiraishi Shoichi, Iwasa Naoki, Kitamura Emi, Mizutani Tetsu, Hanada Yukiko, Yanagihara Takehiko
Department of Neurology, Osaka Police Hospital.
Rinsho Shinkeigaku. 2015;55(7):472-7. doi: 10.5692/clinicalneurol.cn-000668. Epub 2015 Jun 4.
Central nervous system (CNS) aspergillosis with stroke has a high mortality and poor prognosis generally. We report a 78-years-old woman with diabetes mellitus, who developed invasive paranasal sinus aspergillosis with the orbital apex syndrome on the right side and cerebral infarction caused by intracranial occlusion of the right internal carotid artery. Based on the presence of a mass lesion in the ethmoid sinus extending to the orbital apex on the right side with cranial CT, the mass lesion was surgically removed and the pathological examination of the surgical specimen revealed aspergillus mold. Immediately after surgery, we initiated treatment with voriconazole 200 mg × 2/day intravenously for 38 days, and then via feeding tube for 86 days until the galactomannan-aspergillus antigen level in the cerebrospinal fluid became negative at 132 days. She is alive now for almost two years without relapse of aspergillosis. There is no definitive guideline for management of patients with CNS aspergillosis concerning the length of drug treatment and the method for monitoring the response for treatment. We believe that measurement of the galactomannan-aspergillus antigen level in the cerebrospinal fluid might be a useful way of monitoring the efficacy of treatment for CNS aspergillosis.
中枢神经系统（CNS）曲霉菌病合并中风通常死亡率高且预后不良。我们报告一名78岁患有糖尿病的女性，她患上了右侧侵袭性鼻旁窦曲霉菌病并伴有眶尖综合征以及由右侧颈内动脉颅内闭塞引起的脑梗死。根据头颅CT显示右侧筛窦有一肿块病变延伸至眶尖，该肿块病变通过手术切除，手术标本的病理检查显示为曲霉菌。术后立即开始用伏立康唑200 mg×2/天静脉注射治疗38天，然后通过饲管给药86天，直到132天时脑脊液中的半乳甘露聚糖 - 曲霉菌抗原水平变为阴性。她目前存活了近两年，曲霉菌病未复发。关于中枢神经系统曲霉菌病患者的治疗管理，在药物治疗时长和监测治疗反应的方法方面没有明确的指南。我们认为测量脑脊液中的半乳甘露聚糖 - 曲霉菌抗原水平可能是监测中枢神经系统曲霉菌病治疗效果的一种有用方法。
