Bajema Kristina L, Dalesandro Mark F, Fredricks David N, Ramchandani Meena
Department of Medicine, Divison of Allergy and Infectious Diseases, University of Washington, 1959 NE Pacific Street Box 356423, Seattle, WA 98195, USA.
Department of Radiology, University of Washington, Seattle, WA, USA.
Med Mycol Case Rep. 2016 Dec 2;15:1-4. doi: 10.1016/j.mmcr.2016.12.001. eCollection 2017 Mar.
Coccidioides species are endemic to the southwestern United States and typically cause a mild or asymptomatic primary infection. In some instances, infection can disseminate and involve the central nervous system with meningitis being the most common manifestation. Non-osseous spinal cord involvement is exceedingly rare. We report a case of disseminated coccidioidomycosis in an otherwise healthy 20 year old man with diffuse leptomeningeal enhancement, cerebrospinal fluid findings suggestive of meningitis, and intramedullary spinal cord abscesses. Response to treatment occurred with prolonged systemic liposomal amphotericin B and voriconazole. An extended course of steroids was needed to blunt inflammation.
球孢子菌属在美国西南部为地方病，通常引起轻度或无症状的原发性感染。在某些情况下，感染可播散并累及中枢神经系统，脑膜炎是最常见的表现。非骨脊髓受累极为罕见。我们报告一例播散性球孢子菌病，患者为一名20岁健康男性，有弥漫性软脑膜强化、脑脊液检查结果提示脑膜炎及脊髓内脓肿。经长时间应用全身性脂质体两性霉素B和伏立康唑后治疗有效。需要延长类固醇疗程以减轻炎症。
