Cerebral aspergillosis in a patient with chronic lymphocytic leukaemia complicated by Evans syndrome.

IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL
Mortada Elyas, Aly Amer
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Abstract

This case report presents a complex medical scenario involving early 60s female patient with a history of chronic lymphocytic leukaemia (CLL) complicated by Evans syndrome, characterised by autoimmune haemolytic anaemia and immune thrombocytopenia. The patient had received various treatments, including steroids, rituximab, cyclosporine and acalabrutinib. The patient's neurological symptoms began around 3 years prior to presentation, with shaking of her right leg, followed by shaking of both hands, particularly the left hand. She experienced shaking during activities and at rest. Additional symptoms included voice changes, numbness in the feet, dizziness, faintness, fatigue, nausea, vomiting, headaches, walking difficulty, speech changes and back pain. Neurological examination revealed resting tremors, bradykinesia, rigidity and infrequent blinking. An MRI of the brain revealed a 28 mm enhancing intra-axial lesion in the right frontal parietal lobe, accompanied by a 7 mm nodule in the left parietal lobe, both suggestive of neoplastic aetiology. A surgical resection was performed, identifying septate branching fungal hyphae consistent with Aspergillus species, leading to the diagnosis of cerebral aspergillosis. Voriconazole was initiated and subsequently adjusted based on therapeutic drug levels. The patient's treatment course was complicated by declining platelets, diagnosed as thrombocytopenia, and a positive COVID-19 test result. She received rituximab, immunoglobulin therapy and antifungal treatment adjustments. The patient's clinical condition improved, including a reduction in tremors and regained mobility. This case underscores the challenges of managing a patient with CLL-associated immune complications, cerebral aspergillosis and a dynamic treatment plan. Clinicians must consider individualised therapeutic strategies and monitor for treatment-related complications in complex cases like this one.

慢性淋巴细胞白血病合并埃文斯综合征的脑曲霉病1例。
本病例报告提出了一个复杂的医疗场景,涉及60岁早期的女性患者,慢性淋巴细胞白血病(CLL)合并埃文斯综合征,其特征是自身免疫性溶血性贫血和免疫性血小板减少症。患者接受了各种治疗,包括类固醇、利妥昔单抗、环孢素和阿卡拉布替尼。患者的神经系统症状在发病前3年左右开始,先是右腿颤抖,然后是双手颤抖,尤其是左手。她在活动和休息时都会感到颤抖。其他症状包括声音变化、足部麻木、头晕、昏厥、疲劳、恶心、呕吐、头痛、行走困难、语言变化和背痛。神经学检查显示静息性震颤、运动迟缓、僵硬和不常眨眼。脑MRI显示右侧额顶叶轴内病灶28毫米增强,左侧额顶叶伴7毫米结节,均提示肿瘤病因。手术切除后,鉴定出与曲霉种类一致的分离分支真菌菌丝,从而诊断为脑曲霉病。开始使用伏立康唑,随后根据治疗药物水平进行调整。患者的治疗过程因血小板下降而复杂化,诊断为血小板减少症,COVID-19检测结果阳性。她接受了利妥昔单抗、免疫球蛋白治疗和抗真菌治疗调整。患者的临床状况得到改善,包括震颤减少和活动能力恢复。本病例强调了管理与cll相关的免疫并发症、脑曲霉病和动态治疗计划的患者的挑战。临床医生必须考虑个体化的治疗策略,并监测与治疗相关的并发症。
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
BMJ Case Reports
BMJ Case Reports Medicine-Medicine (all)
CiteScore
1.40
自引率
0.00%
发文量
1588
期刊介绍: BMJ Case Reports is an important educational resource offering a high volume of cases in all disciplines so that healthcare professionals, researchers and others can easily find clinically important information on common and rare conditions. All articles are peer reviewed and copy edited before publication. BMJ Case Reports is not an edition or supplement of the BMJ.
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