Kiya K, Sakoda K, Gen M, Harada K, Uozumi T, Ito H
No Shinkei Geka. 1982 Aug;10(8):861-6.
A case of aspergillotic meningoencephalitis associated with trigeminal neuralgia was reported. The patient, a 41-year-old female, was admitted to our hospital on Nov. 20, 1977 with the chief complaint of right trigeminal neuralgia. On admission right facial paresthesia and right abducens palsy were found. The skull x-ray and tomogram showed enlargement of the right superior orbital fissure. Ct scan revealed an irregular high density around the right superior orbital fissure. The examination of spinal fluid showed 75 mg/dl protein, 72 mg/dl sugar and 11 cells. A biopsy of the mass and trigeminal rhizotomy were performed on Dec. 21, 1977. Microscopically, the specimen was composed of nonspecific granulomatous inflammatory tissue. Thereafter, loss of visual acuity, total ophthalmoplegia and facial paresis gradually appeared on the right side with high fever elevation. Immunologically, peripheral blood lymphocytes responded normally to PHA and PWM, but numbers of lymphocytes showed a tendancy of decrease with deterioration. On the other hand, serum IgG and IgM levels were rather increased. CT scan showed that an irregular high density mass extended to the right orbital apex and the pterygoid fossa. Spinal fluid revealed 260 mmH2O pressure with 76 mg/dl protein, 55 mg/dl sugar and 293 cells, but no organisms were demonstrated. Four months after the operation, swelling of the right subtemporal region became remarkable, in which region a puncture revealed much pus retention, and Aspergillus fumigatus was cultured from the aspirated pus. The patient became comatose and died on May 20, 1978. Autopsy showed thick, yellowish green pseudomembranes covering from the right temporal tip to the basal cistern. The both of cerebral hemispheres were swollen and revealed multiple small softenings all over the brain. Small hemorrhage occupying the right temporal subcortex and microabscess located in the left thalamus were also seen. Microscopical examination disclosed that the pseudomembrane was composed of the necrotizing suppurative inflammation with branched septate hypha of Aspergillus. There have been a few reports of aspergillotic meningoencephalitis associated with trigeminal neuralgia and enlargement of the superior orbital fissure like this case. Some discussion was made on the importance for the diagnosis of aspergillosis to perform fungal culture and histological examination of materials obtained from the inflammatory site, and immunological data of this case was also presented.
报告了1例与三叉神经痛相关的曲霉性脑膜脑炎病例。患者为41岁女性，于1977年11月20日因右侧三叉神经痛为主诉入院。入院时发现右侧面部感觉异常和右侧展神经麻痹。头颅X线和体层摄影显示右侧眶上裂扩大。CT扫描显示右侧眶上裂周围有不规则高密度影。脑脊液检查显示蛋白75mg/dl、糖72mg/dl、细胞11个。1977年12月21日对肿块进行活检并进行三叉神经根切断术。显微镜下，标本由非特异性肉芽肿性炎症组织组成。此后，右侧逐渐出现视力丧失、完全性眼肌麻痹和面部轻瘫，并伴有高热。免疫方面，外周血淋巴细胞对PHA和PWM反应正常，但随着病情恶化淋巴细胞数量有减少趋势。另一方面，血清IgG和IgM水平有所升高。CT扫描显示不规则高密度肿块延伸至右侧眶尖和翼腭窝。脑脊液显示压力260mmH₂O，蛋白76mg/dl、糖55mg/dl、细胞293个，但未发现病原体。术后4个月，右侧颞下区肿胀明显，穿刺发现该区域有大量脓液潴留，从吸出的脓液中培养出烟曲霉。患者于1978年5月20日昏迷死亡。尸检显示从右侧颞尖到基底池覆盖有厚的黄绿色假膜。双侧大脑半球肿胀，全脑可见多个小软化灶。还可见占据右侧颞叶皮质下的小出血和位于左侧丘脑的微脓肿。显微镜检查显示假膜由坏死性化脓性炎症和曲霉的分支分隔菌丝组成。已有少数关于与三叉神经痛及如此例眶上裂扩大相关的曲霉性脑膜脑炎的报道。对从炎症部位获取的材料进行真菌培养和组织学检查对曲霉病诊断的重要性进行了一些讨论，并给出了该病例的免疫学数据。
