D'Assumpcao Carlos, Heidari Arash, Johnson Royce H
Kern Medical-UCLA, Bakersfield, CA, USA.
Ross University, Miramar, FL, USA.
J Investig Med High Impact Case Rep. 2018 Dec 20;6:2324709618820047. doi: 10.1177/2324709618820047. eCollection 2018 Jan-Dec.
This is a case of a 56-year-old man diagnosed with coccidioidal meningitis 42 years ago at the age of 14. He was treated with intrathecal amphotericin B deoxycholate by cisternal puncture for 15 years before switching to fluconazole once it became available in 1991. Over 42 years of treatment, he developed hearing loss due to auditory nerve neurotoxicity, hydrocephalus requiring ventriculoperitoneal shunting with associated malfunctions, lumbar arachnoiditis, and hypokalemic paralysis. Regular cerebrospinal fluid studies to this day do not show disease clearance. Many of the lessons from his clinical history are enshrined in the current iteration of the Infectious Diseases Society of America Coccidioidomycosis Treatment Guidelines. To our knowledge, he is the longest surviving coccidioidal meningitis patient.
这是一例56岁男性患者，42年前14岁时被诊断为球孢子菌性脑膜炎。在1991年氟康唑上市之前，他通过小脑延髓池穿刺接受鞘内注射脱氧胆酸两性霉素B治疗达15年。在42年的治疗过程中，他因听神经神经毒性出现听力丧失，因脑积水需要进行脑室腹腔分流术且伴有相关功能障碍，发生了腰椎蛛网膜炎和低钾性麻痹。直至今日，常规脑脊液检查仍未显示疾病清除。他临床病史中的许多经验教训都被纳入了美国传染病学会球孢子菌病治疗指南的当前版本。据我们所知，他是存活时间最长的球孢子菌性脑膜炎患者。
