鞘内注射两性霉素B联合静脉滴注伏立康唑成功救治1例脑曲霉菌病患者

Successful treatment of cerebral aspergillosis with intrathecal injection amphotericin B and intravenous voriconazole

目的脑曲霉菌病的发病率日益增多,治疗药物有限,病死率很高。总结成功救治1例脑曲霉菌病患者的经验。方法立体定向下行脑穿刺活检术,脑组织病理活检结果明确诊断。治疗采用联合抗真菌治疗,伏立康唑0.2 g,2/d,静脉滴注,疗程70 d;间断小剂量鞘内注射两性霉素B,剂量0.1 mg,1/周。结果复查头颅磁共振,与初起病时比较病变明显吸收,临床症状好转。随访3年无复发。结论小剂量两性霉素B鞘内注射联合静脉滴注伏立康唑治疗脑曲霉菌病有较好疗效,无明显不良反应。

Objective Cerebral aspergillosis is increasing with more immunocompromised hosts. At present,the treatment of cerebral aspergillosis is limited,which has a high mortality rate. We treated of a cerebral aspergillosis patient successfully,and provided the clinical reference. Methods We reported a case of a cerebral aspergillosis who was diagnosed by brain biopsy. We therapy with intravenous caspofungin by two 0. 2 g dose /day for 70 days,and combined intermittent small doses of intrathecal injection of amphotericin B by dose of just 0. 1 mg,1 /week. Results A magnetic resonance imaging of the brain and a cranial CT scan were reviewed. Pathological changes were absorbed and clinical symptoms from the previous improved markedly. We reviewed follow-up of 3 years without recurrence. Conclusion Therapy with intravenous caspofungin and combined intermittent small doses of intrathecal injection of amphotericin B has a effect therapy,and which has a low side effect.