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一名看似免疫功能正常的患者出现原发性脑室内出血并伴有播散性隐球菌病。

Disseminated cryptococcosis in an apparently immunocompetent patient presenting with primary intraventricular haemorrhage.

作者信息

Pal Partha, Ray Sayantan, Patra Sisir Kumar, Mukherjee Debabrata

机构信息

Department of General Medicine, Calcutta National Medical College and Hospital, Kolkata, West Bengal, India.

Department of Endocrinology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.

出版信息

BMJ Case Rep. 2015 Oct 22;2015:bcr2015210250. doi: 10.1136/bcr-2015-210250.

Abstract

Disseminated cryptococcosis is uncommon and almost always occurs in HIV-infected patients. However, cryptococcosis can also be found in patients of organ transplantation, in those on disease modifying agents for rheumatological conditions and in patients with underlying immunodeficiency. Cryptococcal infection may occur in an immunocompetent patient, but the pathogenic strain is usually Cryptococcus gattii, and not C. neoformans. However, disseminated disease, especially cerebral involvement in the form of primary intraventricular haemorrhage, is exceedingly rare. We report a case of disseminated cryptococcosis with cutaneous, cerebral and bone marrow involvement in an HIV-negative, apparently immunocompetent patient. Although the patient did not have the usual immunocompromising diseases, there were clinical signs possibly indicating a weakened immune system. This report highlights the need for awareness of disseminated cryptococcosis among patients with no apparent immunocompromising conditions.

摘要

播散性隐球菌病并不常见,几乎总是发生在感染HIV的患者中。然而,隐球菌病也可见于器官移植患者、接受风湿性疾病病情改善药物治疗的患者以及存在潜在免疫缺陷的患者。免疫功能正常的患者也可能发生隐球菌感染,但致病菌株通常是新型隐球菌变种,而非新生隐球菌。然而,播散性疾病,尤其是以原发性脑室内出血形式出现的脑部受累极为罕见。我们报告一例HIV阴性、看似免疫功能正常的患者发生播散性隐球菌病,累及皮肤、脑和骨髓。尽管该患者没有常见的免疫功能低下疾病,但存在可能提示免疫系统减弱的临床体征。本报告强调了在无明显免疫功能低下情况的患者中提高对播散性隐球菌病认识的必要性。

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