Challenges in the diagnosis of leptomeningeal dissemination of glioblastoma in a patient with fever and xanthochromic CSF: a case report.

IF 1.6 Q2 MEDICINE, GENERAL & INTERNAL
Andrei Neagu, Cristian-Mihail Niculae, Irina Lăpădat, Adriana Hristea
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Abstract

Background: Leptomeningeal spread with carcinomatous meningitis is a severe complication of glioblastoma, with a poor prognosis. Diagnosis is challenging, as the sensitivity of classic diagnostic investigations remains low for detecting cerebrospinal fluid (CSF) tumor spread and exclusion of infectious causes is mandatory, especially if unusual clinical findings are present.

Case presentation: A 71-year-old woman was admitted to our hospital for recurrent episodes of high fever and xanthochromic meningitis, with subacute onset. Her past medical history was significant for a left temporal glioblastoma, treated with surgical resection and adjuvant chemo- and radiotherapy, with associated systemic immunosuppression secondary to chemotherapy. An extensive workup especially with molecular microbiology testing for exclusion of infectious causes was performed. CSF was analyzed for typical bacterial and viral causes, but also pathogens associated with immunosuppression, such as Listeria monocytogenes and Cryptococcus neoformans. A therapeutic trial of standard antituberculous drugs with repeated lumbar punctures were needed in order to exclude Mycobacterium tuberculosis and to confirm the diagnosis of carcinomatous meningitis by cytopathological examination of the CSF.

Conclusions: The case describes an unusual clinical presentation of a patient with glioblastoma associated leptomeningeal dissemination, as high fever and xanthochromic CSF could raise important diagnostic and therapeutic challenges in the clinical practice. The diagnosis of carcinomatous meningitis requires an extensive workup for exclusion of infectious causes which is important for urgent oncologic treatment.

发热伴黄色脑脊液的胶质母细胞瘤脑膜播散诊断的挑战:1例报告。
背景:小脑膜扩散伴癌性脑膜炎是胶质母细胞瘤的严重并发症,预后较差。诊断是具有挑战性的,因为传统诊断调查在检测脑脊液(CSF)肿瘤扩散方面的敏感性仍然很低,必须排除感染原因,特别是在出现异常临床表现的情况下。病例介绍:一名71岁妇女因反复发作的高热和黄色脑膜炎而入院,亚急性起病。她的既往病史为左侧颞叶胶质母细胞瘤,接受手术切除和辅助化疗和放疗,化疗后继发全身免疫抑制。进行了广泛的检查,特别是分子微生物检测,以排除感染原因。分析脑脊液的典型细菌和病毒原因,以及与免疫抑制相关的病原体,如单核细胞增生李斯特菌和新型隐球菌。为了排除结核分枝杆菌,并通过脑脊液细胞病理学检查确认癌性脑膜炎的诊断,需要进行标准抗结核药物的治疗试验,并反复腰椎穿刺。结论:该病例描述了一个不寻常的临床表现,患者与胶质母细胞瘤相关的脑脊液播散,高热和黄色脑脊液可能在临床实践中提出重要的诊断和治疗挑战。癌性脑膜炎的诊断需要广泛的检查,以排除感染性原因,这对紧急肿瘤治疗很重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Romanian Journal of Internal Medicine
Romanian Journal of Internal Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
3.20
自引率
5.30%
发文量
35
审稿时长
15 weeks
期刊介绍: Romanian Journal of Physics is a journal publishing physics contributions on the following themes: •Theoretical Physics & Applied Mathematics •Nuclear Physics •Solid State Physics & Materials Science •Statistical Physics & Quantum Mechanics •Optics •Spectroscopy •Plasma & Lasers •Nuclear & Elementary Particles Physics •Atomic and Molecular Physics •Astrophysics •Atmosphere and Earth Science •Environment Protection
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