Meyerowitz Eric A, Sanchez Sarimer, Mansour Michael K, Triant Virginia A, Goldberg Marcia B
Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Open Forum Infect Dis. 2020 Nov 13;7(12):ofaa552. doi: 10.1093/ofid/ofaa552. eCollection 2020 Dec.
Mucormycosis involves life-threatening rapidly progressive angioinvasion with infiltration across tissue planes, resulting in necrosis and thrombosis, most commonly seen in the setting of immunocompromised states. We describe 2 cases of isolated cerebral mucormycosis in immunocompetent adults and describe this syndrome in detail in the context of a systemic literature review.
Using the criteria (1) isolated cerebral disease, (2) mucormycosis (by polymerase chain reaction, culture, or pathology), and (3) affected an immunocompetent individual, we identified 53 additional cases from 1969 to 2020.
Of these 55 cases, ~60% occurred in men, >70% were in patients under age 35, 92% were associated with intravenous drug use, and >85% had infection centered in the basal ganglia. Many presented with cranial nerve deficits, headache, focal weakness, or altered mental status.
No patient survived without amphotericin, and steroid administration was associated with worse outcomes. Given the current opioid crisis, this syndrome may be seen more frequently.
毛霉病涉及危及生命的快速进展性血管侵袭，可跨组织平面浸润，导致坏死和血栓形成，最常见于免疫功能低下状态。我们描述了2例免疫功能正常的成年人孤立性脑毛霉病病例，并在系统文献综述的背景下详细描述了该综合征。
使用以下标准：（1）孤立性脑部疾病；（2）毛霉病（通过聚合酶链反应、培养或病理学诊断）；（3）患者免疫功能正常，我们从1969年至2020年期间又识别出53例病例。
在这55例病例中，约60%为男性，超过70%的患者年龄在35岁以下，92%与静脉吸毒有关，超过85%的感染集中在基底神经节。许多患者表现为颅神经功能缺损、头痛、局灶性无力或精神状态改变。
未经两性霉素治疗，无一例患者存活，使用类固醇与更差的预后相关。鉴于当前的阿片类药物危机，这种综合征可能会更频繁地出现。
