Disseminated phaeohyphomycosis due to Cladophialophora bantiana in an immunocompetent child

IF 2.2 4区医学 Q3 MYCOLOGY

Journal de mycologie medicale Pub Date : 2024-02-24 DOI:10.1016/j.mycmed.2024.101467

Aakash Mahesan , Abin Sheref Mohammed , Gautam Kamila , Prashant Jauhari , Biswaroop Chakrabarty , Sumanta Das , Prasenjit Das , Vaishali Suri , Sudesh Gourav , Immaculata Xess , Atin Kumar , Sheffali Gulati

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Abstract

A 3-year-old boy presented with acute headache, vomiting and right focal clonic seizures without history of fever, joint pain or altered sensorium. Neuroimaging showed multifocal contrast enhancing lesions with significant perilesional edema. CECT chest and abdomen showed multiple variable sized nodules in the lungs and hypodense lesion in liver with mesenteric lymphadenopathy. There was persistent eosinophilia with maximum upto 35 %. Liver biopsy and brain biopsy revealed Cladophialophora bantiana. He was treated with IV liposomal amphotericin and voriconazole for 6 weeks with repeat neuroimaging showing more than 50 % resolution of the intracranial lesions. He was transitioned to oral combination of flucytosine and voriconazole. At 14 months follow-up, he remained symptom free with complete radiological resolution of the lesions and no eosinophilia. High suspicion, an aggressive approach in obtaining microbiological diagnosis and timely combination antifungal therapy may give satisfactory outcome without surgery.

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一名免疫功能正常的儿童患上由班氏栉水母引起的散发性噬菌体病

一名 3 岁男孩因急性头痛、呕吐和右侧局灶性阵挛发作就诊，无发热、关节痛或感觉改变病史。神经影像学检查显示多灶性造影剂增强病变，周围水肿明显。胸部和腹部CECT显示肺部有多个大小不等的结节，肝脏有低密度病变，肠系膜淋巴结病变。嗜酸性粒细胞增多，最高可达 35%。肝活组织检查和脑活组织检查发现了 Cladophialophora bantiana。他接受了为期6周的两性霉素脂质体和伏立康唑静脉注射治疗，重复的神经影像学检查显示颅内病变消退了50%以上。随后，他转为口服氟尿嘧啶和伏立康唑的复方制剂。在 14 个月的随访中，他仍无症状，放射学显示病灶完全消退，且无嗜酸性粒细胞增多。高度怀疑、积极获得微生物学诊断并及时进行联合抗真菌治疗可在不进行手术的情况下获得满意的结果。

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

Journal de mycologie medicale 医学-真菌学

CiteScore

5.10

自引率

2.80%

发文量

审稿时长

6-12 weeks

期刊介绍： The Journal de Mycologie Medicale / Journal of Medical Mycology (JMM) publishes in English works dealing with human and animal mycology. The subjects treated are focused in particular on clinical, diagnostic, epidemiological, immunological, medical, pathological, preventive or therapeutic aspects of mycoses. Also covered are basic aspects linked primarily with morphology (electronic and photonic microscopy), physiology, biochemistry, cellular and molecular biology, immunochemistry, genetics, taxonomy or phylogeny of pathogenic or opportunistic fungi and actinomycetes in humans or animals. Studies of natural products showing inhibitory activity against pathogenic fungi cannot be considered without chemical characterization and identification of the compounds responsible for the inhibitory activity. JMM publishes (guest) editorials, original articles, reviews (and minireviews), case reports, technical notes, letters to the editor and information. Only clinical cases with real originality (new species, new clinical present action, new geographical localization, etc.), and fully documented (identification methods, results, etc.), will be considered. Under no circumstances does the journal guarantee publication before the editorial board makes its final decision. The journal is indexed in the main international databases and is accessible worldwide through the ScienceDirect and ClinicalKey platforms.