Cryptococcal osteomyelitis and meningitis in a patient with non-hodgkin's lymphoma treated with PEP-C.
Cryptococcal osteomyelitis and meningitis in a patient with non-hodgkin's lymphoma treated with PEP-C.
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使用 PEP-C 治疗的非霍奇金淋巴瘤患者的隐球菌骨髓炎和脑膜炎。
DOI：
10.1136/bcr.08.2011.4578
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发表时间：
2012
期刊：
影响因子：
0.9
通讯作者：
Fan,AliceC
中科院分区：
文献类型：
--
作者：
To,ChristinaA;Hsieh,RobertW;McClellan,JamesScott;Howard,Walter;Fischbein,NancyJ;Brown,JaniceMY;Felsher,DeanW;Fan,AliceC
我们提出了第一个病例报告的淋巴瘤患者谁发展为播散性隐球菌骨髓炎和脑膜炎，而正在与PEP-C（泼尼松，依托泊苷，甲基苄肼和环磷酰胺）化疗方案治疗。在发热和新的骨病变的检查中，肋骨活检的真菌培养显示患者患有隐球菌性骨髓炎。进一步的评估显示并发隐球菌性脑膜炎。患者的播散性隐球菌感染在完整的抗真菌治疗后完全消退。隐球菌性骨髓炎本身是一种非常罕见的诊断，我们的淋巴瘤患者并发隐球菌性脑膜炎的独特表现可能是由于他接受了PEP-C治疗。众所周知，长期强化化疗方案使患者面临非典型感染的风险;但医生应该认识到，即使是慢性低剂量治疗也会使患者面临真菌感染的风险。医生应该考虑真菌感染作为PEP-C淋巴细胞减少患者感染性检查的一部分。
We present the first case report of a lymphoma patient who developed disseminated cryptococcal osteomyelitis and meningitis while being treated with the PEP-C (prednisone, etoposide, procarbazine and cyclophosphamide) chemotherapy regimen. During work-up of fever and new bony lesions, fungal culture from a rib biopsy revealed that the patient had cryptococcal osteomyelitis. Further evaluation demonstrated concurrent cryptococcal meningitis. The patient’s disseminated cryptococcal infections completely resolved after a full course of antifungal treatment. Cryptococcal osteomyelitis is itself an extremely rare diagnosis, and the unique presentation with concurrent cryptococcal meningitis in our patient with lymphoma was likely due to his PEP-C treatment. It is well recognized that prolonged intensive chemotherapeutic regimens place patients at risk for atypical infections; yet physicians should recognize that even chronic low-dose therapies can put patients at risk for fungal infections. Physicians should consider fungal infections as part of the infectious work up of a lymphopenic patient on PEP-C.