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摘要: 目的：提高对中枢神经系统曲霉病（CNS-A）的认识。方法：报告1例急性白血病患者造血干细胞移植后经过真菌培养和病理确诊的CNS-A，并进行相关文献复习。结果：急性白血病患者，相关不合移植后免疫残留升高，减停免疫抑制剂后出现移植物抗宿主病，加用免疫抑制剂后出现发热和癫痫，头颅MRI可见右侧额叶和枕叶两个长T1长T2病灶，给予伏立康唑后好转，立体定向下活检病理可见大量的曲霉菌丝，引流液培养出有丝真菌。结论：骨髓移植后中枢神经系统曲霉病不少见，发展迅速，预后恶劣，临床表现和影像学表现缺乏特异性，快速诊断困难，一旦考虑CNS-A就应及时尽早使用伏立康唑治疗。伏立康唑和手术治疗是目前治疗CNS-A的有效手段。Abstract: Objective: To improve the understanding of central nervous system aspergillosis(CNS-A) after hematopoietic stem cell transplantation.Method: A proven case of CNS-A was reported and relevant literatures were reviewed.Result: Immunosuppressive agents for patient with acute leukemia were withdrawn after related mismatched bone marrow transplantation due to elevated minimal residual disease detected by flow cytometry.Graft versus host disease(GVHD) occurred and immunosuppressive agents restarted.Fever and seizure were presented.MRI of head showed two leisions in right frontal and occipital lobe.Stereotactic brain biopsy were performed after twenty-four days Voriconazole treatment.Pathology showed abundant branched septated haphae.Fungal culture of purulent was positive.Conclusion: CNS-A is not uncommon after hematopoietic stem cell transplantation.The diagnosis is diffcult because clinical manifestation and CT scan and MRI are not specific.Voriconazole should be given as soon as the diagnosis is considered.Voriconazole and surgery treatment may be the best effective treatment.
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Key words:
- central nervous system /
- aspergillosis /
- invasive fungal infection
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[1] DENNING D W.Therapeutic outcome of invasive aspergillosis[J].Clin Infect Dis, 1996, 23:608-615.
[2] SCHWARTZ S, RUHNKE M, RIBAUD P, et al.Improved outcome in central nervous system aspergillosis, using voriconazole treatment[J].Blood, 2005, 106:2641-2645.
[3] KLEINSCHMIDT DEMASTERS B K.Central nervous system aspergillosis:a 20-year retrospective series[J].Hum Pathol, 2002, 33:116-124.
[4] JANTUNEN E, VOLIN L, SALONEN O, et al.Central nervous system aspergillosis in allogeneic stem cell transplant recipients[J].Bone Marrow Transplant, 2003, 31:191-196.
[5] OKAFUJI T, YABUUCHI H, NAGATOSHI Y, et al.CT and MR findings of brain aspergillosis[J].Comput Med Imagging Graph, 2003, 27:489-492.
[6] MASCHKE M.DIETRICH U, PRUMBAUM M, et al.Opportunistic CNS infection after bone marrow transplantation[J].Bone Marrow Transplant, 1999, 23:1167-1176.
[7] ERDOGAN E, BEYZADEOGLU M, ARPACI F, et al.Cerebellar aspergillosis:case report and literature review[J].Neurosurgery, 2002, 50:874-877.
[8] LIAPIS K, MANAKA K, BALTADAKIS I, et al.Cerebral aspergillosis[J].Eur J Haematol, 2009, 82:327-328.
[9] HIDRON A I, GONGORA M C, ANDERSON A M, et al.Prolonged survival of a patient with AIDS and central nervous system aspergillosis[J].Med Mycol, 2009, 47:327-330.
[10] VISCOLI C, MACHETTI M, GAZZOLA P, et al.Aspergillus galactomannan antigen in the cerebrolspinal fluid of bone marrow transplant recipient with propable cerebral aspergillosis[J].J Clin Microbiology, 2002, 40:1496-1499.
[11] WEBER C, SCHAPER J, TIBUSSEK D, et al.Diagnostic and therapeutic implications of neurological complications following paediatric haematopoietic stem cell transplantation[J].Bone Marrow Transplant, 2008, 41:253-259.
[12] KOMATSU H, FUJISAWA T, INUI A, et al.Molecular diagnosis of cerebral aspergillosis by sequence analysis with panfungal polymerase chain reaction[J].J Pediatr Hematol Oncol, 2004, 26:40-44.
[13] LACERDA J F, MARTINS C, CARMO J A, et al.Invasive aspergillosis of the central nervous system after allogeneic stem cell transplantation[J].J Infect, 2005, 51:e191-194.
[14] YAMADA K, SHRIER D A, RUBIO A, et al.Imaging findings in intracranial aspergillosis[J].Acad Radiol, 2002, 9:163-171.
[15] SCHWARTZ S, RUHNKE M, RIBAUD P, et al.Poor efficacy of amphotericin B-based therapy in CNS aspergillosis[J].Mycoses, 2007, 50:196-200.
[16] SCHWARTZ S, REISMAN A, TROKE PF, et al.The efficacy of voriconazole in the treatment of 192 fungal central nervous system infections:a retrospective analysis[J].Infection, 2011, 39:201-210.
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