Zhang Shaoyang, Fu Qinghui, Chen Qi, Liang Ting-Bo
Department of SICU The Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Province, China.
Medicine (Baltimore). 2017 Dec;96(48):e8908. doi: 10.1097/MD.0000000000008908.
Cerebral aspergillosis (CA) is a rare manifestation of invasive aspergillosis. It usually affects seriously immunocompromised hosts. Pancreatic bacterial or/and fungal infection is common in patients with severe acute pancreatitis.
We report the first case of an immunocompetent woman with infected necrotizing pancreatitis due to multidrug resistant Acinetobacter baumannii who, in the course of treatment, developed isolated CA.
Magnetic resonance imaging, rather than computed tomography, revealed latent homolateral sinus disease-the possible source of the Aspergillus infection.
The pancreatic infection was controlled by open necrosectomy, and the CA was disappeared after neuronavigation-guided drainage and voriconazole antifungal therapy.
The patient was discharged without complications. Our report revealed that persistent hyperglycemia, sepsisassociated immunoparalysis, and prolonged antibiotic use could impair severe patient's immunocompetence, making them more susceptible to opportunistic cerebral Aspergillus infection; the risk may be especially high in patients with paranasal sinus diseases.
Timely neurosurgical intervention combined with voriconazole antifungal therapy can provide a favorable outcome.
脑曲霉病（CA）是侵袭性曲霉病的一种罕见表现形式。它通常影响严重免疫功能低下的宿主。胰腺细菌或/和真菌感染在重症急性胰腺炎患者中很常见。
我们报告了首例具有免疫能力的女性病例，该患者因多重耐药鲍曼不动杆菌感染导致坏死性胰腺炎，在治疗过程中发生了孤立性CA。
磁共振成像而非计算机断层扫描显示了潜在的同侧鼻窦疾病——曲霉感染的可能来源。
通过开放性坏死组织清除术控制胰腺感染，在神经导航引导下引流并使用伏立康唑抗真菌治疗后CA消失。
患者无并发症出院。我们的报告显示，持续性高血糖、脓毒症相关的免疫麻痹以及长期使用抗生素会损害重症患者的免疫能力，使其更容易发生机会性脑曲霉感染；对于患有鼻窦疾病的患者，这种风险可能尤其高。
及时的神经外科干预联合伏立康唑抗真菌治疗可带来良好的结果。
