Aoba S, Komiyama A, Hasegawa O
Department of Neurology, Yokohama City University School of Medicine.
Rinsho Shinkeigaku. 1993 Apr;33(4):462-4.
The patient, an otherwise healthy 42-year-old woman, developed non-throbbing periorbital pain and abducens nerve palsy of the right side two weeks prior to the present admission. Under the diagnosis of Tolosa-Hunt syndrome, she had been placed on prednisolone (30 mg/day) in another hospital, leading to exacerbation of her neurologic manifestations. On admission, neurologic examination revealed bilateral abducens nerve palsy, incomplete bilateral oculomotor paresis, and hypalgesia in the first and the second branch of the left trigeminal nerve. On CSF examination there were 742/mm3 white blood cells of which about 80% of the cells were neutrophils. The glucose was 70 mg/dl (blood glucose was 170 mg/dl) and the protein 49 mg/dl. Although repeated cultures for bacteria or fungi were negative, PAS stains for CSF sediments showed a large number of yeasts morphologically consistent with a Malassezia species. Anti-fungal treatment with fluconazole and flucytosine resulted in dramatic improvement both in neurologic signs and laboratory findings. According to morphological criteria, the yeasts found in CSF sediments from this patient differed from those described previously as being pathogenetic in the CNS fungal infection. By contrast, these yeasts were similar to a Malassezia species in all aspects. Because some Malassezia requires oil for its growth in culture, it is possible that it failed to grow in the standard media and thus escaped recognition.
患者为一名42岁的健康女性，本次入院前两周出现右侧非搏动性眶周疼痛和展神经麻痹。在另一家医院被诊断为托洛萨-亨特综合征后，她开始服用泼尼松龙（30毫克/天），结果导致神经症状加重。入院时，神经系统检查发现双侧展神经麻痹、双侧动眼神经不完全麻痹以及左侧三叉神经第一和第二分支感觉减退。脑脊液检查显示白细胞计数为742/立方毫米，其中约80%为中性粒细胞。葡萄糖含量为70毫克/分升（血糖为170毫克/分升），蛋白质含量为49毫克/分升。尽管多次进行细菌或真菌培养均为阴性，但脑脊液沉淀物的PAS染色显示大量形态与马拉色菌属一致的酵母。使用氟康唑和氟胞嘧啶进行抗真菌治疗后，神经体征和实验室检查结果均有显著改善。根据形态学标准，该患者脑脊液沉淀物中发现的酵母与先前描述的中枢神经系统真菌感染的致病酵母不同。相比之下，这些酵母在各方面都与马拉色菌属相似。由于一些马拉色菌在培养时需要油脂才能生长，因此有可能它在标准培养基中未能生长，从而未被识别出来。
