卷曲病与大脑最佳管理案例展示。

Archives of emergency medicine and critical care Pub Date : 2022-01-01 Epub Date: 2022-08-18
Matthew Goldman, Ramya Reddy, Brandon Lucke-Wold, Arnav Barpujari, Miles Cameron, Ken Porche, Dimitri Laurent, Ernesto Duarte, Brian C Lobo, Matthew Koch
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摘要

背景:卷曲孢子菌是一种普遍存在于热带气候中的真菌,有报道称它生长在大麻叶片上。它能感染人类并从鼻窦传播到大脑的情况非常罕见:一名 28 岁的免疫功能健全的患者因鼻息肉、头痛和右侧细微视力障碍而就诊。影像学检查发现,似乎有一个侵入性肿块通过乙状窦和鼻窦长入前颅窝:结果:耳鼻喉科进行了鼻内窥镜活检,病理和培养结果与卷曲菌一致(图 6)。手术计划由神经外科和耳鼻喉科联合进行。外科医生采用双额叶开颅和鼻内镜方法进行了大体全切除。切除术后,根据传染病部门的建议,患者接受了为期4周的两性霉素治疗,随后又接受了为期12个月的伏立康唑治疗。手术后患者的病情一直很稳定:卷曲病毒是一种罕见但可能危及生命的中枢神经系统感染,可通过吸食大麻感染。该病例说明了积极清创和广谱抗真菌治疗对优化治疗效果的重要性。随着大麻的日益流行,卷曲孢子菌应纳入鉴别诊断。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Curvularia and the Brain: Case Demonstration of Optimal Management.

Curvularia and the Brain: Case Demonstration of Optimal Management.

Curvularia and the Brain: Case Demonstration of Optimal Management.

Background: Curvularia is a ubiquitous fungus found in tropical climates and has been reported to grow on marijuana leaves. Rarely, it can infect humans and propagate from the nasal sinuses into the brain.

Case: A 28-year-old immunocompetent patient presented with history of nasal polyps, headache, and subtle visual deficits on the right. Imaging revealed what appeared to be an invasive mass growing through the ethmoid and sphenoid sinuses into the anterior cranial fossa.

Results: Otolaryngology performed an endoscopic nasal biopsy with pathology and cultures consistent for Curvularia (figure 6). A combination case with neurosurgery and otolaryngology was planned. Surgeons used a bifrontal craniotomy and endonasal approach for gross total resection. Following resection, the patient was placed on 4 weeks of amphotericin treatment followed by 12 months of voriconazole based on recommendations by infectious disease. The patient has been stable since surgery.

Conclusion: Curvularia is a rare but potentially life threatening central nervous system infection that can be acquired from inhalational marijuana use. This illustrative case shows the importance of aggressive debridement followed by broad spectrum antifungal treatment to optimize outcome. With marijuana's increasing popularity, Curvalaria should be included on the differential diagnosis.

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