Xu Jordan, Nault Rod J, Maldonado-Naranjo Andres, Frizon Leonardo A, John Kuruvilla, Holman Katherine, Nagel Sean J
Case Western Reserve Univerisity School of Medicine, 2109 Adelbert Rd, Cleveland, OH 44106, United States.
Department of Neurosurgery, Neurological Institute, Cleveland Clinic Foundation, 9600 Euclid Ave, Cleveland, OH 44195, United States.
J Clin Neurosci. 2018 Apr;50:127-128. doi: 10.1016/j.jocn.2018.01.057. Epub 2018 Feb 7.
Infections are one of the most common causes of mortality in immunocompromised patients. In patients diagnosed with hematologic malignancies, treatment with stem cell transplants (SCT) or T-cell suppressing chemotherapy increases the risk of central nervous system (CNS) infections, of which toxoplasmosis is the most common. We report the case of a 63 year-old woman with chronic lymphocytic leukemia (CLL) that presented with gait instability and visual changes. Intracranial lesions were noted on initial neuro-imaging. A rapid decline in the patient's mental status warranted an urgent biopsy of the lesions that revealed tachyzoites consistent with toxoplasmosis. In the presence of diffuse brain lesions that lack a metastatic pattern or contrast enhancement, a common approach is to perform biopsy only after a battery of non-invasive testing. This diagnostic delay may take several days, exposing the patient to a rapidly fatal infection. This report illustrates the utility of early brain biopsy in high-risk patients with hematologic malignancies and CNS lesions.
感染是免疫功能低下患者最常见的死亡原因之一。在被诊断为血液系统恶性肿瘤的患者中，进行干细胞移植（SCT）或T细胞抑制化疗会增加中枢神经系统（CNS）感染的风险，其中弓形虫病最为常见。我们报告了一例63岁慢性淋巴细胞白血病（CLL）女性患者，该患者出现步态不稳和视力改变。初次神经影像学检查发现颅内病变。患者精神状态迅速恶化，因此对病变进行了紧急活检，结果显示速殖子，符合弓形虫病。在存在缺乏转移模式或对比增强的弥漫性脑病变的情况下，常见的做法是在进行一系列非侵入性检查后才进行活检。这种诊断延迟可能需要数天时间，使患者面临迅速致命的感染。本报告说明了早期脑活检在患有血液系统恶性肿瘤和CNS病变的高危患者中的作用。
