Xie Haiting, Luo Peng, Li Zhongli, Li Rui, Sun Haitao, Wu Duobin
Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510282, P.R. China.
Exp Ther Med. 2017 Jul;14(1):780-784. doi: 10.3892/etm.2017.4554. Epub 2017 Jun 7.
The aim of the present study was to investigate the treatment of refractory encephalitis with continuous administration of liposomal amphotericin B (AmB). Liposomal AmB was administered to a 28-year-old male by intravenous injection, with daily increasing dosages up to 150 mg per day and combined use of fluconazole (0.4 g per day) and oral flucytosine tablets (1.5 g per day). Following 5 months of treatment, could still be detected in the ink stain of cerebrospinal fluid, but the patient could not tolerate a further increase in the dosage of liposomal AmB. Instead, continuous intrathecal administration of AmB through tube drainage on the lumbar cistern was used. A total dosage of 28 mg liposomal AmB was administered to the patient over the course of 1 month. The effect of AmB administered by intravenous injection was not as great as expected and the patient's tolerance was not good. However, the patient recovered following treatment by continuous intrathecal administration of AmB through tube drainage on the lumbar cistern for 1 month. This case suggests that continuous intrathecal administration of liposomal AmB should be considered for clinical treatment of refractory cryptococcal encephalitis.
本研究的目的是探讨持续应用脂质体两性霉素B（AmB）治疗难治性脑炎的效果。对一名28岁男性患者静脉注射脂质体AmB，每日剂量递增至150mg/d，并联合使用氟康唑（0.4g/d）和口服氟胞嘧啶片（1.5g/d）。治疗5个月后，脑脊液墨汁染色仍可检测到（相关物质），但患者无法耐受脂质体AmB剂量的进一步增加。取而代之的是，通过腰椎池置管引流持续鞘内注射AmB。1个月内患者共接受了28mg脂质体AmB。静脉注射AmB的效果不如预期，患者耐受性也不佳。然而，通过腰椎池置管引流持续鞘内注射AmB治疗1个月后患者康复。该病例提示，对于难治性新型隐球菌性脑炎的临床治疗，应考虑持续鞘内注射脂质体AmB。
