Sakusic Amra, Chen Baibing, McPhearson Kimberly, Badi Mohammed, Freeman William D, Huang Josephine F, Siegel Jason L, Jentoft Mark E, Oring Justin M, Verdecia Jorge, Meschia James F
Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA.
Department of Neurocritical Care, Mayo Clinic, Jacksonville, Florida, USA.
Open Forum Infect Dis. 2023 Feb 21;10(3):ofad094. doi: 10.1093/ofid/ofad094. eCollection 2023 Mar.
We present the case of a 61-year-old woman with a history of orthotopic heart transplant who was hospitalized with new-onset headache. Magnetic resonance imaging (MRI) of the brain revealed T2 hyperintense signal involving the left occipital lobe with leptomeningeal enhancement and mild vasogenic edema. Initial neurologic examination was normal; however, after 7 days she developed imbalance, visual disturbances, night sweats, bradyphrenia, alexia without agraphia, and right hemianopsia. Brain MRI showed enlargement of the left occipital mass and worsening edema. Stereotactic needle biopsy showed nondiagnostic necrosis. The patient continued to deteriorate despite dexamethasone. Cerebrospinal fluid (CSF) suggested infection, and cytomegalovirus CSF polymerase chain reaction (PCR) was positive. The patient received vancomycin, imipenem, and ganciclovir. After obtaining a positive serum beta-D-glucan (Fungitell), amphotericin was added. Despite best medical efforts, the patient died. Postmortem broad-range PCR sequencing of the brain tissue was positive for rare amoeba .
我们报告一例61岁原位心脏移植术后女性患者，因新发头痛入院。脑部磁共振成像（MRI）显示左侧枕叶T2高信号，软脑膜强化，伴有轻度血管源性水肿。初次神经系统检查正常；然而，7天后她出现了平衡失调、视觉障碍、盗汗、思维迟缓、失读不伴失写、右侧偏盲。脑部MRI显示左侧枕叶肿块增大，水肿加重。立体定向针吸活检显示为非特异性坏死。尽管使用了地塞米松，患者病情仍持续恶化。脑脊液（CSF）提示感染，巨细胞病毒脑脊液聚合酶链反应（PCR）呈阳性。患者接受了万古霉素、亚胺培南和更昔洛韦治疗。在血清β-D-葡聚糖（Fungitell）检测呈阳性后，加用了两性霉素。尽管全力救治，患者仍死亡。脑组织尸检广谱PCR测序显示罕见变形虫阳性。
