Successful Treatment of an Aspergillus Brain Abscess with Caspofungin: Case Report of a Diabetic Patient Intolerant of Amphotericin B
Successful Treatment of an Aspergillus Brain Abscess with Caspofungin: Case Report of a Diabetic Patient Intolerant of Amphotericin B
复制标题
卡泊芬净成功治疗曲霉菌脑脓肿：两性霉素 B 不耐受的糖尿病患者病例报告
DOI：
10.1007/s10096-003-0991-6
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发表时间：
2003
影响因子：
4.5
通讯作者：
R. Rosas
中科院分区：
文献类型：
--
作者：
A. Colombo;R. Rosas
曲霉病可能发生在各种临床环境中，包括接受长期类固醇治疗或癌症化疗的患者，接受器官移植的患者或感染人类免疫缺陷病毒的患者。在所有侵袭性曲霉病病例中，脑曲霉病可能发生率高达20%;然而，只有在极少数病例中，脑才是唯一的感染部位[1]。曲霉属致脑脓肿。在免疫功能正常的患者中很少报告[2]。我们描述了一个糖尿病患者的脑脓肿所造成的曲霉菌。一位66岁的女性糖尿病患者，1年前曾因木梁在额顶叶区域遭受颅脑创伤，到急诊室就诊，主诉持续6个月的前额头痛和颅骨肿胀。除了右侧颞顶骨区域肿胀（表现出炎症体征）外，体格检查无异常。除轻度高血糖（180 mg/dl）外，血液学和生化实验室检查均正常。随后的头颅计算机断层扫描（CT）显示软组织感染和骨髓炎区域，并显示在颞顶叶区域存在连续脑脓肿，周围有脑水肿（图1A，B）。未检测到潜在脑区的其他结构异常。
Aspergillosis may occur in a variety of clinical settings, including patients undergoing prolonged steroid therapy or cancer chemotherapy, patients who have undergone organ transplantation, or patients infected by the human immunodeficiency virus. Cerebral aspergillosis may occur in up to 20% of all cases of invasive aspergillosis; however, only in rare cases is the brain the sole site of infection [1]. Brain abscess due to Aspergillus spp. has been reported infrequently among immunologically competent patients [2]. We describe a diabetic patient with a brain abscess caused by Aspergillus spp. who was successfully treated with caspofungin, the first in a new class of antifungal agents known as the glucan synthesis inhibitors.A 66-year-old female diabetic patient who had suffered cranial trauma at the fronto-parietal region with a wooden beam 1 year previously presented to the emergency room complaining of frontal headache of 6 months’ duration and swelling of the skull. The physical examination was unremarkable except for swelling at the right temporo-parietal region, which exhibited inflammatory signs. Hematological and biochemical laboratory tests were normal except for mild hyperglycemia (180 mg/dl). A subsequent cranial computed tomography (CT) scan showed an area consistent with soft tissue infection and osteomyelitis and revealed the presence of a contiguous brain abscess at the temporo-parietal region circumscribed by cerebral edema (Fig. 1A, B). No other structural abnormalities in the underlying brain areas were detected.