Yin SiJia, Xu Yan, Huang Jinsha, Xiong Nian, Han Chao, Ma Kai, Guo Xing Fang, Xia Yun, Wan Fang, Kou Liang, Sun Yadi, Wu Jiawei, Wang Tao
Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Life Sciences and Medicine, The First Affiliated Hospital, University of Science and Technology of China, Hefei, China.
Front Neurol. 2019 Aug 6;10:812. doi: 10.3389/fneur.2019.00812. eCollection 2019.
A 47-year-old HIV-seronegative woman with autoimmune hemolytic anemia (AIHA) was treated with corticosteroids for 8 months. She developed central nervous system dysfunction and was diagnosed with cryptococcal meningitis (CM) after detecting cryptococcus neoformans in the cerebrospinal fluid. The patient's clinical symptoms were worsened and unusual MRI findings of white matter lesions were noticed even after adequate treatment, which were quite unusual compared with typical characteristics of CM. This led us to carry out further investigations. Similar cases have been reported previously in published literature. Combined with clinical symptoms and MRI findings, the most likely diagnosis was Cryptococcal Meningitis-Immune Reconstitution Inflammatory Syndrome. Unfortunately, the patient deteriorated and died of respiratory failure. Cryptococcal Meningitis-Immune Reconstitution Inflammatory Syndrome may have MRI changes during the early onset of the disease (bilateral basal ganglia). We propose that close monitoring of the condition, meticulous MRI follow-up and brain biopsies should be indicated in such cases for treating them actively, so as to avoid worsening of the patients' condition.
一名47岁的HIV血清阴性女性，患有自身免疫性溶血性贫血（AIHA），接受了8个月的皮质类固醇治疗。她出现了中枢神经系统功能障碍，在脑脊液中检测到新型隐球菌后被诊断为隐球菌性脑膜炎（CM）。即使经过充分治疗，患者的临床症状仍恶化，并且发现了不寻常的白质病变MRI表现，与CM的典型特征相比非常不寻常。这促使我们进行进一步调查。先前在已发表的文献中曾报道过类似病例。结合临床症状和MRI表现，最可能的诊断是隐球菌性脑膜炎-免疫重建炎症综合征。不幸的是，患者病情恶化，死于呼吸衰竭。隐球菌性脑膜炎-免疫重建炎症综合征在疾病早期（双侧基底节）可能会出现MRI变化。我们建议，对于此类病例，应密切监测病情，进行细致的MRI随访并进行脑活检，以便积极治疗，避免患者病情恶化。
