Okamoto K, Kuroiwa A, Yokoyama Y, Kamoda F, Kinumaki H, Shitara N
Department of Neurosurgery, Tokyo Metropolitan Komagome Hospital, Japan.
No To Shinkei. 1996 Nov;48(11):1047-51.
A case of cerebral aspergillosis during induction chemotherapy for acute lymphoblastic leukemia was described. A 5-year-old boy complained of headache and left homonymous hemianopsia during induction chemotherapy for acute lymphoblastic leukemia. CT scan and MR imaging survey demonstrated cerebral fungal lesion as well as multifocal lung lesions. A cerebral lesion appeared as a low density mass in right occipital lobe with marginal enhancement on CT scan, and iso- and high-signal intensity appeared with marginal gadolinium enhancement on T1- and T2-weighted MR imaging. Although fungus balls in the lung responded well to daily intravenous administration of amphotericin-B for 2 months, the cerebral lesion showed a rather expansive character as invading into neighbouring falx, opposite occipital lobe, meninges, and occipital bone. Extensive removal of the brain lesion from the parenchyma, falx, invaded dura, and skull was surgically performed. The lesion was confirmed as aspergillosis by Grocott's methenamine histological stain. Surgical intervention and concomitant use of amphotericin-B for a month resulted in complete remission of the aspergillosis. After 6 years, a cranioplasty was successfully completed for the occipital bone defect.
描述了1例急性淋巴细胞白血病诱导化疗期间发生脑曲霉病的病例。一名5岁男孩在急性淋巴细胞白血病诱导化疗期间出现头痛和左侧同向性偏盲。CT扫描和磁共振成像检查显示脑部有真菌病变以及肺部多灶性病变。脑部病变在CT扫描中表现为右枕叶低密度肿块，边缘强化，在T1加权和T2加权磁共振成像上表现为等信号和高信号强度，边缘有钆强化。尽管肺部的真菌球对每天静脉注射两性霉素B 2个月反应良好，但脑部病变表现出相当的侵袭性，侵入邻近的大脑镰、对侧枕叶、脑膜和枕骨。通过手术广泛切除脑实质、大脑镰、受累硬脑膜和颅骨的病变。通过Grocott六胺银组织学染色确诊病变为曲霉病。手术干预并同时使用两性霉素B一个月导致曲霉病完全缓解。6年后，成功完成了枕骨缺损的颅骨成形术。
