Aydın Mehtap, Özçelik Ümit, Çevik Halime, Çınar Özlem, Evren Ebru, Demirağ Alp
From the Department of Infectious Diseases and Clinical Microbiology, Baskent University School of Medicine, Istanbul, Turkey.
Exp Clin Transplant. 2015 Nov;13 Suppl 3:77-80. doi: 10.6002/ect.tdtd2015.P31.
Fungal brain abscesses are a rare but serious complication in transplant recipients. Phialemonium organisms are rare causes of invasive mold infections. Here, we present the first case of a renal transplant recipient with multiple brain abscesses caused by Phialemonium infection A. A 51-year-old female kidney transplant recipient was admitted with pneumonia of an unknown cause and treated with empiric intravenous antibiotics. Her treatment was uneventful, and she was discharged 1010 days later. After 5 days, she was readmitted with fever, cerebral palsy, and speech disorder. The patient had undergone living-donor renal transplant 7 months earlier. A cranial computed tomography and magnetic resonance imaging were performed for a possible cerebrovascular pathology. The magnetic resonance imaging scan showed multiple brain abscesses located at the left parietal, frontal and occipital lobes; right parietal and occipital lobes; right basal ganglia; and left cerebellum. The patient received meropenem, linezolid, sulfamethoxazole and trimethoprim, and AmBisome for probable pathogenic infection, and immunosuppressive agents dosage was reduced increasingly immunosuppressed. We identified Phialemonium in cerebrospinal fluid culture. The patient received voriconazole 200 mg twice daily. Lesions could not be drained due to lack of capsula formation. The patient died on the 30th day of antifungal therapy. Phialemonium organisms, although a rare cause of fungal infections, are associated with a high mortality rate in immunocompromised patients. To our knowledge, this is the first case report in the literature describing multiple brain abscesses due to Phialemonium in a transplant recipient. Clinicians recipient should be alert about these rare opportunistic fungi in the differential diagnosis of brain abscess, and bronchoscopy and bronchoalveolar lavage are recommended for transplant patients when they are admitted with pneumonia exclude fungal infections.
真菌性脑脓肿是移植受者中一种罕见但严重的并发症。瓶霉属微生物是侵袭性霉菌感染的罕见病因。在此，我们报告首例由瓶霉属感染导致多发脑脓肿的肾移植受者病例。一名51岁的女性肾移植受者因不明原因的肺炎入院，接受经验性静脉抗生素治疗。她的治疗过程顺利，10天后出院。5天后，她因发热、脑瘫和言语障碍再次入院。该患者7个月前接受了活体供肾肾移植。针对可能的脑血管病变进行了头颅计算机断层扫描和磁共振成像检查。磁共振成像扫描显示多个脑脓肿位于左侧顶叶、额叶和枕叶；右侧顶叶和枕叶；右侧基底节；以及左侧小脑。患者接受美罗培南、利奈唑胺、磺胺甲恶唑和甲氧苄啶以及两性霉素B脂质体治疗以应对可能的病原体感染，免疫抑制剂剂量逐渐减少。我们在脑脊液培养中鉴定出瓶霉属。患者接受伏立康唑每日两次，每次200毫克治疗。由于缺乏包膜形成，病变无法引流。患者在抗真菌治疗的第30天死亡。瓶霉属微生物虽然是真菌感染罕见的病因，但在免疫功能低下的患者中与高死亡率相关。据我们所知，这是文献中首例描述移植受者因瓶霉属导致多发脑脓肿的病例报告。临床医生在脑脓肿的鉴别诊断中应警惕这些罕见的机会性真菌，对于因肺炎入院的移植患者，当排除真菌感染时，建议进行支气管镜检查和支气管肺泡灌洗。
