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非免疫功能低下患者的颅内真菌感染:一例病例报告及文献复习

Intracranial fungal infection in a nonimmunocompromised patient: A case report and review of the literature.

作者信息

Kilbourn Kent J, Green Jaquise, Zacharewski Nicholas, Aferzon Joseph, Lawlor Michael, Jaffa Matthew

机构信息

Department of Neurosurgery, Hartford Hospital, Hartford, Connecticut, United States.

Department of Infectious Disease, Hartford Hospital, Hartford, Connecticut, United States.

出版信息

Surg Neurol Int. 2022 Apr 22;13:165. doi: 10.25259/SNI_116_2022. eCollection 2022.

Abstract

BACKGROUND

is a dematiaceous fungus that rarely infects the central nervous system (CNS). It is associated with a mortality rate of over 70% despite treatment.

CASE DESCRIPTION

An 81-year-old female with a remote history of renal cell carcinoma presented with progressive headache and an expressive aphasia for 3 days. Computed tomography imaging revealed a left frontotemporal mass with surrounding vasogenic edema. A left frontotemporal craniotomy was performed and cultures revealed . The initial management with IV voriconazole was unsuccessful and the patient had a recurrence of the cranial infection and developed pulmonary abscesses. Following the addition of oral flucytosine, the patient showed a significant improvement with a complete radiographic resolution of both the cranial and pulmonary lesions.

CONCLUSION

involving the CNS is a rare and often fatal disease. Surgical management along with standard antifungal treatment may not provide definitive therapy. The addition of flucytosine to IV voriconazole resulted in a positive outcome for this patient who is alive, living independently 1 year from the original diagnosis. In this rare fungal infection, standard antifungal treatment may not provide adequate coverage and the utilization of additional therapy may be required.

摘要

背景

是一种暗色真菌,很少感染中枢神经系统(CNS)。尽管进行了治疗,但其死亡率仍超过70%。

病例描述

一名有肾细胞癌既往史的81岁女性,出现进行性头痛和表达性失语3天。计算机断层扫描成像显示左额颞叶肿块伴周围血管源性水肿。进行了左额颞叶开颅手术,培养结果显示 。最初使用静脉注射伏立康唑治疗未成功,患者出现颅骨感染复发并发展为肺脓肿。加用口服氟胞嘧啶后,患者病情显著改善,颅骨和肺部病变在影像学上完全消退。

结论

累及中枢神经系统是一种罕见且通常致命的疾病。手术治疗与标准抗真菌治疗可能无法提供确定性治疗。在静脉注射伏立康唑基础上加用氟胞嘧啶,使该患者获得了积极的治疗结果,自最初诊断起1年后仍存活且独立生活。在这种罕见的真菌感染中,标准抗真菌治疗可能无法提供足够的覆盖范围,可能需要使用额外的治疗方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7ecf/9062923/b10b889845d6/SNI-13-165-g001.jpg

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