Cryptococcal Meningitis Presenting as Transient Aphasia

以暫時性失語症為表現之隱球菌腦膜炎

蕭振倫(Cheng-Lun Hsiao) ； 林信光(Shinn-Kuang Lin)

《童綜合醫學雜誌》 8卷2期 (2014/12) Pp. 100-105

摘要

隱球菌腦膜炎對愛滋病患者是最重要的伺機感染之一，也是造成早期死亡的一個主要因素。頭痛、發燒、頸部僵硬、及意識改變是最常見之臨床表現。腦神經麻痺或視乳頭水腫也曾經被提及。但暫時性失語從未被報告為隱球菌腦膜炎的初期表現。對於隱球菌腦膜炎目前之標準治療為將兩性黴素B（amphotericinB）合併5-氟胞嘧啶（flucytosine）投予兩週做為引導治療，之後以氟康唑（fluconazole）作為鞏固和維持治療。我們報告一位64歲女性隱球菌腦膜炎患者以罕見的類似暫時性腦缺血的暫時性失語症作為初期症狀。病患拒絕接受兩性黴素B之治療。我們改以每日靜脈注射400毫克氟康唑兩週並接續每日口服450毫克氟康唑六個月治療。病患對此抗黴菌治療不論在臨床症狀或是實驗室檢查結果上皆呈現良好的反應，並且在接下來一年內的追蹤都相當健康。暫時性失語症也可能是隱球菌腦膜炎之初始表現。在一位免疫能力正常且疾病輕微之患者，早期診斷並且及早使用氟康唑作為單一治療仍可以有良好之結果。

關鍵字

隱球菌腦膜炎 ； 暫時性失語症

並列摘要

Cryptococcal meningitis (CM) is one of the most important opportunistic infection and is a major contributor to early mortality in patients with human immunodeficiency virus (HIV). Headache, fever, neck stiffness, and altered mental state are the most frequent clinical findings. Cranial nerve palsies and papilledema have also been reported. However, transient aphasia has never been reported as an initial presentation of CM. The standard therapy for CM is an induction phase of 2 weeks with a combination of the fungicides amphotericin B and flucytosine, prior to consolidation and maintenance therapy with fluconazole. Here we report the unusual case of a 64-year-old woman who had transient aphasia, mimicking a transient ischemic attack, as the initial presentation of CM. The patient refused therapy with amphotericin B and was given daily intravenous fluconazole, 400 mg for 2 weeks, followed by oral daily fluconazole, 450 mg for a total of 6 months. She responded to antifungal therapy well and had a good recovery both clinically and in laboratory studies and she remained healthy at 1-year follow-up. We believe that in this case, transient aphasia was the initial clinical presentation of CM. In an immunocompetent patient with a minor degree of CM, early diagnosis and early monotherapy with fluconazole may yield a good clinical outcome.

並列關鍵字

cryptococcal meningitis ； transient aphasia ； fluconazole