症状类似脑梗塞的肺隐球菌病晚期复发:病例报告。

IF 1 Q4 INFECTIOUS DISEASES
Case Reports in Infectious Diseases Pub Date : 2024-10-04 eCollection Date: 2024-01-01 DOI:10.1155/2024/3905985
Anatoli Pinchuk, Gernot Geginat, Volker Rickerts, Belal Neyazi, Klaus Peter Stein, Christian Mawrin, I Erol Sandalcioglu, Ali Rashidi
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引用次数: 0

摘要

隐球菌病是一种由新型隐球菌和加特隐球菌引起的感染,主要侵犯艾滋病患者的中枢神经系统(CNS),但并不局限于艾滋病患者。这种疾病也可发生在患有各种免疫抑制疾病的人身上,经常累及大脑或肺部。隐球菌脑膜炎(CM)是最常见的真菌性脑膜脑炎,可导致脑内感染、脑梗塞或脑积水。脑膜炎的临床表现无特异性,影像学特征也会有很大差异。本病例报告的患者为一名脑梗死患者,HIV 阴性,但长期接受可的松治疗。值得注意的是,该患者在脑部受累前15年曾有肺隐球菌病史。最初到我们诊所就诊时,脑活检的组织学和培养结果均为阴性,而且之前的肺隐球菌病史也不清楚。随后,在血清和脑脊液(CSF)中检测到了隐球菌抗原,并从脑脊液中培养出了新变形隐球菌。该病例强调了对脑瘤保持高度怀疑的重要性,尤其是对既往有隐球菌感染史的患者,同时也证明了因脑瘤继发血管事件而导致脑活检结果假阴性的可能性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Late Relapse of Previous Pulmonary Cryptococcosis With Symptoms Resembling Cerebral Infarction: A Case Report.

Cryptococcosis, an infection caused by Cryptococcus neoformans and Cryptococcus gattii, predominantly targets the central nervous system (CNS) in patients with AIDS but is not limited to this group. The disease can also occur in individuals with various immunosuppressive conditions, frequently involving the brain or lungs. Cryptococcal meningitis (CM) is the most common form of fungal meningoencephalitis, leading to intracerebral infections, cerebral infarction, or hydrocephalus. The clinical presentation of CM is nonspecific, and imaging features can vary significantly. This case report presents a patient with cerebral infarction, who was HIV-negative but had been on long-term cortisone therapy. Notably, the patient had a history of pulmonary cryptococcosis 15 years prior to cerebral involvement. When initially at our clinic, histology and culture results from brain biopsies were negative and the earlier pulmonary cryptococcosis history was unknown. Subsequently, cryptococcal antigen was detected in both serum and cerebrospinal fluid (CSF), and C. neoformans was cultivated from CSF. This case highlights the critical importance of maintaining a high index of suspicion for CM, particularly in patients with a history of previous cryptococcal infections, and it also demonstrates the possibility of false-negative brain biopsy results due to secondary vascular events associated with CM.

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