A case of HIV-associated cerebral histoplasmosis successfully treated with fluconazole
A case of HIV-associated cerebral histoplasmosis successfully treated with fluconazole
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DOI：
10.1007/s100960050368
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发表时间：
1999-09-01
影响因子：
4.5
通讯作者：
Rieger, A
中科院分区：
文献类型：
--
作者：
Knapp, S;Turnherr, M;Rieger, A
在播散性组织胞浆菌病病例中，临床上明显累及中枢神经系统的情况很少见。即使是在艾滋病毒感染者中也是如此。尽管使用两性霉素B进行治疗，但死亡率仍然很高。本文报道一例HIV感染者，有3个月发烧、咳嗽、体重减轻和肺部粟粒样渗出的病史。开始抗结核治疗四周后，出现高烧、神经症状、人格改变和呼吸恶化。脑部核磁共振成像显示多个肿块，胸部X光片显示肺浸润物恶化。肺活检标本的亚甲胺银染色显示有组织胞浆体。随后，从灌洗液中培养出该病原菌。在大剂量静脉注射氟康唑治疗(每天一次800毫克)后，患者的病情在10天内显著改善，随后肺部和大脑肿块病变几乎完全消失。这被认为是第一例在使用氟康唑诱导治疗后，HIV感染患者的播散性组织胞浆菌病迅速改善并累及中枢神经系统的记录病例。
Clinically apparent involvement of the central nervous system is a rare event in cases of disseminated histoplasmosis. even in HIV-infected persons. Despite therapy with amphotericin B, mortality remains very high. Reported here is the case of an HIV-infected patient with a 3-month history of fever, cough, weight loss and miliary lung infiltrates. Four weeks after initiation of tuberculostatic therapy, high-grade fever, neurological symptoms, personality changes and respiratory deterioration occurred. Magnetic resonance imaging of the brain showed multiple mass lesions, and a chest radiograph revealed worsening of pulmonary infiltrates. Methenamine silver staining of a lung biopsy specimen demonstrated Histoplasma capsulatum. Subsequently, this pathogen was cultured from lavage fluid. Following high-dose intravenous fluconazole therapy (800 mg once daily), the patient's condition improved markedly within 10 days, followed by an almost complete resolution of pulmonary and cerebral mass lesions. This is believed to be the first documented case of rapid improvement of disseminated histoplasmosis with central nervous system involvement in an HIV-infected patient upon induction of therapy with fluconazole.