免疫功能正常少年患早期表现为复视的隐球菌脑膜炎1例(英文)

Cryptococcus meningitis in an immunocompetent teenage boy presented early with diplopia

目的:报告免疫力正常少年的隐球菌脑膜炎1例,早期表现为复视和双眼视力低下。方法:病例报告。结果:男,17岁,两眼视物模糊并复视3wk,伴随严重的搏动性头痛、恶心、呕吐及低热。经体格检查无发热及假性脑膜炎迹象。双眼视力为6/15并视野缩窄。双眼前段正常。眼外肌运动表明双侧第六神经麻痹。眼底检查显示双侧视盘充血和轻度隆起。CT扫描大脑正常,无颅内肿块或脑室异常。腰椎穿刺发现高开放压>300mmH2O。脑脊液显微镜下及培养均存在新型隐球菌。本例由神经医疗组联合处理。患者开始静脉注射两性霉素B和氟康唑,神经症状1wk后恢复,双眼视力提高到6/6,同时周边视野恢复。随着第六神经麻痹的康复双眼复视得到好转。结论:本例强调了隐球菌脑膜炎进展缓慢的性质。即使免疫功能正常,也不会存在明显的假性脑膜炎特征,复视可能是脑膜炎患者的早期表现之一。

AIM： To report a case of cryptococcus meningitis in an immunocompetent teenager that presented early with diplopia and bilateral poor vision. METHODS .A case report RESULTS：A 17-year-old boy presented with blurring of vision in both eyes and diplopia for 3 weeks, It was associated with severe throbbing headaches, nausea and vomiting, He was also having low grade fever. On physical examination he was afebrile with no sign of meningism, His vision was 6/15 in both eyes with constricted visual field. Anterior segment was normal in both eyes, Extraocular muscles movement showed bilateral sixth nerve palsies, Fundoscopy revealed bilateral hyperaemic and slightly elevated optic disc. CT scan of the brain was normal with no evidence of intracrania/ mass or abnormal ventricles, Lumbar puncture revealed high opening pressure 〉 300mmH20, Cerebrospinal fluid （CSF） microscopically and culture showed presence of cryptocoecus neoformans, This case was combinedly managed with neuro-medlcal team. Patient was started on intravenous Amphoterlcln B and fluconazole. His neurological symptoms recovered after a week. His vision was improved to 6/6 in both eyes with recovery of peripheral visual field. The dlplopia improved with recovery of sixth nerve palsies in both eyes, Unfortunately, patient developed nosocomial lower respiratory tract infection and was treated for the problem. CONCLUSION, This case highlights the indolent nature of cryptococcus meningitis and the fact that the overt signs of meningism may not be present even in immunocompetent person. Diplopla may be one of the early presentations of meningitis patient.