CAJ | 학술논문

目的总结1例皮炎外瓶霉所致中枢神经系统感染的病例资料并复习相关文献.方法通过对北京儿童医院收治的l例8岁患皮炎外瓶霉所致中枢神经系统感染的男性患儿2012至2014年两次住院期间的临床资料进行总结分析,并进行相关文献的复习.探讨本病的临床表现,影像学改变,诊断及治疗.结果患儿8岁,主因“头晕2个月,间断发热1个月伴抽搐2次”于2012年9月首次入院.患儿曾于入院前2年发现胆管占位性病变,病理检查提示真菌,给予不系统抗真菌治疗.患儿此次发病后逐渐出现神经系统症状,并出现了意识障碍及肢体活动的异常.入院前头颅MRI的检查提示颅内多发的占位性病变,伴有病灶周围水肿.最终脑活检病理检查提示丝状真菌,培养结果确诊为外瓶霉.入院后给予了两性霉素B脂质体、伏立康唑及5-氟胞嘧啶的联合抗真菌治疗以及对症处理.经正规系统治疗后患儿病情逐渐好转,意识逐渐恢复,治疗2个月余患儿可以与人正常交流,并可以自行活动.监测头颅影像提示病灶范围略有缩小,病灶周围水肿减轻.后续改为伏立康唑口服维持.出院口服药物约1年4个月,患儿病情稳定,临床无明显异常表现,定期监测头颅影像,仍提示有颅内病灶,但有所减小.2014年2月患儿再次出现病情变化,头晕、颈部疼痛,头痛以及进行性的神经系统症状,包括:间断抽搐、咳嗽无力及意识障碍,脑脊液检查中再次培养出外瓶霉,并应用PCR从分子水平成功地对外瓶霉进行鉴别,确诊为皮炎外瓶霉再次住院给予积极治疗,但最终患儿死亡.结论皮炎外瓶霉所致的中枢神经系统感染发病率低,临床罕见,临床表现与其他真菌所致的颅内感染无特异性差别,影像学可有颅内团块样病灶,确诊仍有赖于病理检查及培养结果,由于病情重,诊治经验少,预后差.
목적 총결1례피염외병매소치중추신경계통감염적병례자료병복습상관문헌.방법 통과대북경인동의원수치적l례8세환피염외병매소치중추신경계통감염적남성환인2012지2014년량차주원기간적림상자료진행총결분석,병진행상관문헌적복습.탐토본병적림상표현,영상학개변,진단급치료.결과 환인8세,주인“두훈2개월,간단발열1개월반추휵2차”우2012년9월수차입원.환인증우입원전2년발현담관점위성병변,병리검사제시진균,급여불계통항진균치료.환인차차발병후축점출현신경계통증상,병출현료의식장애급지체활동적이상.입원전두로MRI적검사제시로내다발적점위성병변,반유병조주위수종.최종뇌활검병리검사제시사상진균,배양결과학진위외병매.입원후급여료량성매소B지질체、복립강서급5-불포밀정적연합항진균치료이급대증처리.경정규계통치료후환인병정축점호전,의식축점회복,치료2개월여환인가이여인정상교류,병가이자행활동.감측두로영상제시병조범위략유축소,병조주위수종감경.후속개위복립강서구복유지.출원구복약물약1년4개월,환인병정은정,림상무명현이상표현,정기감측두로영상,잉제시유로내병조,단유소감소.2014년2월환인재차출현병정변화,두훈、경부동통,두통이급진행성적신경계통증상,포괄:간단추휵、해수무력급의식장애,뇌척액검사중재차배양출외병매,병응용PCR종분자수평성공지대외병매진행감별,학진위피염외병매재차주원급여적겁치료,단최종환인사망.결론 피염외병매소치적중추신경계통감염발병솔저,림상한견,림상표현여기타진균소치적로내감염무특이성차별,영상학가유로내단괴양병조,학진잉유뢰우병리검사급배양결과,유우병정중,진치경험소,예후차.
Objective To summarize the clinical features,imaging characteristics,diagnosis and treatment of a case with central nervous system infection caused by Exophiala dermatitidis,as well as to review the related literature.Method Associated literature and clinical data of an 8-year-old boy who was diagnosed as central nervous system infection caused by Exophiala dermatitidis in Beijing Children's Hospital Affiliated to Capital Medical University and hospitalized twice from 2012 to 2014 were analyzed retrospectively.Result The boy was 8 years old with the chief complaint of dizziness for 2 months,intermittent fever for 1 month accompanied with spasm twice.He was diagnosed as bile ducts spaceoccupying lesions 2 years ago,when the pathological diagnosis was fungal infection.The boy was treated with iiregular anti-fungal therapy.Then the boy developed nervous symptoms,impaired consciousness and abnormal physical activity that developed gradually.After hospitalization the cerebral MRI of the boy showed space-occupying lesions accompanied with edema of surrounding area.Filamentous fungi was found by brain biopsy,which was culture positive for Exophiala dermatitidis.After diagnosis the boy was treated with amphotericin B (AMB),voriconazole and 5-Fu,as well as symptomatic treatment.The state of the boy was improved gradually.Two months later,the boy could communicate with others normally and move personally.The lesions and edema seen on the MRI was decreased moderately.Accordingly,the boy was treated with oral voriconazole maintenance treatment for about 1 year and 4 months after discharge.During this period,the state of him was stable without symptoms.The lesions shown by MRI did not disappear but decreased on regular examination.However,recently the disease of the boy progressed again,with dizziness,neck pain,headache and progressive nervous symptoms (intermittent spasm,inability to cough,and impaired consciousness).The boy died at last,even with the active treatment at the second hospitalization.Exophiala dermatitidis was culture-positive again in his CSF,and was confirmed by PCR successfully.Conclusion The central nervous system infection caused by Exophiala dermatitidis is rare.Clinical features of this disease were similar to those of other fungal CNS infection,cerebral MRI of which could show the similar lumpy lesions.Diagnosis of the disease should be based on pathology and culture.