麴菌腦膿瘍一病例報告

Aspergillosis of the Central Nervous System with Brain Abscess-A Case Report-

劉文玉(Wen-Yu Liou) ； 朱梦麟(Mong-Ling Chu) ； 趙治中(Chih-Chung Chao) ； 馬宏爲(Hung-Wa Ma) ； 杜炎昌(Yang-Chan Tu)

《Acta Paediatrica Sinica》 25卷3期 (1984/09) Pp. 308-312

摘要

麹菌腦膿瘍是小兒罕見的疾病，本文報告一個10歲女性病例，因發高燒、頭病、意識不清、抽搐而住院，經腦部電腦斷層攝影及左頸動脈攝影證實爲腦膿瘍後，病人接受顱骨切開及膿瘍切除術，但於手術後6天死亡。生檢切片及解剖結果均發現其爲一麹腦膿瘍病例。由於本病人診斷與治療較難，特此提出報告並討論之。

並列摘要

A case of cerebral aspergillosis, with formation of an abscess, is reported. The patient, a 10-year-old female, was transferred from another hospital because of high fever, headache, and vomiting for four days, plus convulsions and a loss of consciousness for two days Aside from observed nuchal rigidity, the physical examination was unremarkable. Neurological examination showed that the patient was semicomatous with normal ocular fundi and isocoric normal pupils. Reaction to light was sluggish. Spastic paralysis of the right lower and left upper limbs was observed, along with involuntary movement of the left lower extremity. Deep tendon reflexes were exaggerated. Babinski's sign was positive on the right side, while Brudzinski's and Kernig's signs were positive on Doth sides. Clear fluid was obtained from a lumbar puncture with initial pressure of 240 mm of H2O, CSP protein of 70 mg/dl, and 210 white cells/mm^3 (10% neutrophils, 90% lymphocytes). Repeated cerebrospinal fluid cultures for bacteria and fungi showed no growth. Cryptoroccal antigen was negative. Therapeutic trials with chloramphenicol and penicillin were not successful. A CT scan of the brain showed an abscess 45×40 mm in diameter at the left deep fronto-temporo-parietal region, involving the left basal ganglia, with the midline shifting to the right. Craniotomy and total removal of the abscess were performed. Unfortunately the patient expired six days postoperatively. Pathological examination (biopsy and autopsy) demonstrated a number of multinucleated giant cells and the branched hyphae characteristic of aspergillus.

並列關鍵字

cerebral aspergillosis ； abscesss formation