Intracranial invasive aspergillosis originating in the sphenoid sinus: a successful treatment with high-dose itraconazole in three cases.
Intracranial invasive aspergillosis originating in the sphenoid sinus: a successful treatment with high-dose itraconazole in three cases.
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原发于蝶窦的颅内侵袭性曲霉病：大剂量伊曲康唑成功治疗三例。
DOI：
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发表时间：
2004
影响因子：
2.2
通讯作者：
Teiji Yamamoto
中科院分区：
文献类型：
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作者：
T. Yamanoi;K. Shibano;Tomoko Soeda;A. Hoshi;Y. Matsuura;Y. Sugiura;K. Endo;Teiji Yamamoto
我们报告三例颅内曲霉菌病起源于免疫功能正常的患者的蝶窦。所有患者均表现为眶尖综合征，其中单侧视力丧失和第III颅神经麻痹，1例还表现为对侧受累。尽管最初使用常规剂量的伊曲康唑（ITCZ，200 mg/天）进行治疗，但神经功能缺损未能改善，肉芽肿性炎症也未得到抑制。因此，我们用500-1000 mg/天（16-24 mg/kg/天）的高剂量ITCZ和0.5 mg/kg/天的阿替霉素B（AMPH-B）联合1000 mg/天的甲基强的松龙脉冲剂量进行治疗。2例反应良好，眼球运动完全恢复，其最大血清羟基ITCZ浓度分别为7816 ng/ml和5370 ng/ml。然而，另一例病例恶化，尽管ITCZ以16 mg/kg/天剂量给药，羟基ITCZ的血清浓度为3863 ng/ml。通过硬膜外入路进行海绵窦手术减压，ITCZ剂量增加至24 mg/kg/天。羟基ITCZ的血清浓度为4753 ng/ml，该病例的结局良好。这些结果表明，高水平的羟基ITCZ的血液（超过4500 ng/ml）是成功治疗颅内曲霉菌病的先决条件，ITCZ与AMPH-B的联合治疗将是首选。如果在强化药物治疗的情况下侵袭性仍不能得到良好控制，则应考虑合并使用类固醇和/或手术减压。
We report three cases of intracranial aspergillosis originating in the sphenoid sinus in immunocompetent patients. The patients presented with an orbital apex syndrome in that a unilateral loss of vision and cranial nerve III palsy were seen in all cases and a contralateral involvement was also seen in one case. Despite the initial treatment with a conventional dose of itraconazole (ITCZ, 200 mg/day), the neurological deficits failed to improve and the granulomatous inflammation was not suppressed. Therefore, we treated with a combination of a high dose of ITCZ at 500-1000 mg/day (16-24 mg/kg/day) and amphotericin B (AMPH-B) at 0.5 mg/kg/day, in conjunction with a pulse dose of methylprednisolone at 1000 mg/day. Two cases responded favorably in that the ocular movements completely recovered, and their maximum serum concentrations of the hydroxy ITCZ were 7816 ng/ml and 5370 ng/ml. However, the other case worsened, despite ITCZ treatment at 16 mg/kg/day, and the serum concentration of the hydroxy ITCZ was 3863 ng/ml. The surgical decompression of the cavernous sinus via an extradural approach was performed, and the dose of ITCZ was increased to 24 mg/kg/day. The resulting serum concentration of the hydroxy ITCZ was 4753 ng/ml, and the outcome of this case has been favorable. These results suggest that a high blood level of the hydroxy ITCZ (more than 4500 ng/ml) is a prerequisite for the successful treatment of intracranial aspergillosis and that the combination treatment of ITCZ with AMPH-B would be preferred. The concomitant use of steroid and/or surgical decompression should be considered, if the invasiveness is not well-controlled in spite of intensive medical therapy.
影响因子：
158.5
作者：
Herbrecht, R;Denning, DW;de Pauw, B
通讯作者：
de Pauw, B