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糖尿病患者中由 引起的(转移性样病变)败血症性脑栓子的不寻常病例。

An Unusual Case (Metastatic-Like Lesion) of Septic Cerebral Embolus Caused by in a Diabetic Patient.

机构信息

University of Szeged, Szeged, Hungary.

出版信息

J Investig Med High Impact Case Rep. 2020 Jan-Dec;8:2324709620930930. doi: 10.1177/2324709620930930.

Abstract

Septic cerebral emboli can be a challenging diagnosis to give, especially if atypical bacterial infections are the cause of it. Correct diagnosis of this condition can change the management route of the patient and result in a nonsurgical treatment. To our best knowledge, this is the first case of septic cerebral embolus caused by reported. In this study, a 65-year-old diabetic patient who have developed ketoacidosis and went into coma was investigated for a case of septic cerebral embolization. The patient developed a sudden right-sided hemiparesis, and the radiological findings showed a tumor-like lesion on the left hemisphere at the level of the internal capsule. At first glance, presence of a metastatic tumor could not be excluded; therefore, further laboratory tests and examinations were done to rule out metastatic lesions. The blood culture of the patient revealed a case of bacteremia caused by and then a septic cerebral embolus was suspected, but due to the rarity of this pathogen causing such complications as well as the similarity of the lesion to a metastatic brain tumor, a biopsy was performed and the histopathological findings confirmed the diagnosis of a septic cerebral embolus. should be considered a human pathogen in immunocompromised patients and it can cause cerebral septic embolization. Metastatic brain tumors and tuberculomas should be excluded; if the uncertainty of a metastatic tumor remains, biopsy can be performed and histological findings can amplify the diagnosis of septic cerebral embolus.

摘要

感染性脑栓塞的诊断具有一定挑战性,尤其是由非典型细菌感染引起时。正确诊断该疾病可以改变患者的治疗方案,并采取非手术治疗。据我们所知,这是首例由 引起的感染性脑栓塞病例。本研究报道了 1 例 65 岁糖尿病患者,因酮症酸中毒并发昏迷,后诊断为感染性脑栓塞。患者突发右侧偏瘫,影像学检查显示左侧内囊水平有肿瘤样病变。初诊时,不能排除转移性肿瘤的可能;因此,进一步进行了实验室检查和检查,以排除转移性病变。患者的血培养显示由 引起的菌血症,随后怀疑为感染性脑栓塞,但由于这种病原体引起如此并发症的罕见性,以及病变与转移性脑肿瘤的相似性,因此进行了活检,组织病理学检查结果证实了感染性脑栓塞的诊断。 在免疫功能低下的患者中应被视为人类病原体,可引起脑感染性栓塞。应排除转移性脑肿瘤和结核瘤;如果对转移性肿瘤的不确定性仍然存在,可以进行活检,组织学发现可以放大感染性脑栓塞的诊断。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/68d0/7273552/ae30caaf3401/10.1177_2324709620930930-fig1.jpg

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