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HIV 阴性患者感染新型隐球菌性脑膜脑炎后的感染后炎症反应综合征:病例报告及文献复习。

Post-infectious inflammatory response syndrome in an HIV-negative patient after Cryptococcus gattii meningoencephalitis: a case report and review of the literature.

机构信息

The 2nd Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang Province, China.

Department of Infectious Diseases, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, Zhejiang Province, China.

出版信息

J Med Case Rep. 2023 Aug 5;17(1):332. doi: 10.1186/s13256-023-04066-x.

Abstract

BACKGROUND

Cryptococcal meningitis (CM) is an inflammatory mycosis of the central nervous system caused by meninge infection or brain parenchyma with Cryptococcus species. It is associated with high morbidity and mortality, and patients with acquired immune deficiency syndrome are particularly susceptible. There have been increasing reports of CM in HIV-negative patients in China over the last few years.

CASE PRESENTATION

A 31-year-old healthy Chinese male presented with fever and gradually developed headache, projectile vomiting, and other manifestations that were later confirmed as Cryptococcus gattii meningoencephalitis. However, multiple disease changes occurred during the course of treatment, and the regimen was accordingly modified after the diagnosis of post-infectious inflammatory response syndrome (PIIRS). The patient eventually recovered.

CONCLUSION

There has been a growing trend in the incidence of C. gattii meningoencephalitis in HIV-negative patients. It shows rapid onset and severe prognosis. This case report can provide a reference to treat PIIRS following CM in HIV-negative patients.

摘要

背景

隐球菌性脑膜炎(CM)是一种中枢神经系统炎症性真菌感染,由脑膜感染或脑组织中的隐球菌引起。它与高发病率和死亡率相关,获得性免疫缺陷综合征患者尤其易患。近年来,中国 HIV 阴性患者中 CM 的报告越来越多。

病例介绍

一名 31 岁健康的中国男性出现发热,随后逐渐出现头痛、喷射性呕吐等症状,后来被确诊为新型隐球菌脑膜脑炎。然而,在治疗过程中出现了多种病情变化,在诊断为感染后炎症反应综合征(PIIRS)后对治疗方案进行了调整。最终患者康复。

结论

HIV 阴性患者中新型隐球菌脑膜脑炎的发病率呈上升趋势。它表现为快速发病和严重的预后。本病例报告可为治疗 HIV 阴性患者 CM 后发生的 PIIRS 提供参考。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/74ec/10403845/8965ecb60b09/13256_2023_4066_Fig1_HTML.jpg

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