Hessler Christine, Kauffman Carol A, Chow Felicia C
Department of Neurology, University of California, San Francisco, CA, USA.
Infectious Diseases Section, Veterans Affairs Ann Arbor Healthcare System, University of Michigan Medical School, Ann Arbor, MI, USA.
Neurohospitalist. 2017 Jan;7(1):30-34. doi: 10.1177/1941874416641468. Epub 2016 Apr 5.
Chronic meningitis of unknown etiology is a vexing illness for patients and clinicians. Identification of the correct pathogen can be challenging and time consuming, leading to delays in appropriate treatment. Although is a recognized and treatable cause of chronic meningitis, neurologists and infectious diseases physicians may not regularly evaluate for infection. We describe an immunocompetent patient with chronic meningitis who partially responded to empiric fluconazole. Prompted by a recent culture-confirmed case of meningeal sporotrichosis, we tested for antibodies from the cerebrospinal fluid, which were positive. His clinical and functional status improved, and the antibody titer decreased with itraconazole therapy. Clinicians should consider in the differential diagnosis for chronic meningitis, even in immunocompetent patients, particularly when the clinical picture does not respond to standard empiric therapy.
病因不明的慢性脑膜炎对患者和临床医生来说是一种棘手的疾病。确定正确的病原体具有挑战性且耗时，会导致适当治疗的延迟。尽管[病原体名称]是慢性脑膜炎的一种已被认可且可治疗的病因，但神经科医生和传染病医生可能不会定期对[病原体名称]感染进行评估。我们描述了一名患有慢性脑膜炎的免疫功能正常患者，其对经验性氟康唑治疗有部分反应。受近期一例经培养确诊的脑膜孢子丝菌病病例的启发，我们检测了脑脊液中的[病原体名称]抗体，结果呈阳性。他的临床和功能状态有所改善，随着伊曲康唑治疗，[病原体名称]抗体滴度下降。临床医生在慢性脑膜炎的鉴别诊断中应考虑[病原体名称]，即使是在免疫功能正常的患者中，尤其是当临床表现对标准经验性治疗无反应时。
