利奈唑胺治疗难治性耐药结核性脑膜炎1例及文献复习

Effects of linezolid in the treatment of a patient with refractory drug-resistant tuberculous meningitis: one case report and literature review

目的:提高对利奈唑胺治疗难治性耐药结核性脑膜炎的认识。方法:报道1例利奈唑胺治疗难治性耐药结核性脑膜炎患者的临床表现、影像所见、治疗和预后,并复习相关文献进行讨论。结果:患者为青年女性,临床表现为发热、头痛,影像学提示"双肺弥漫性粟粒性阴影、脑实质弥漫性结节影、脑积水",脑脊液培养结核分枝杆菌阳性,药敏提示耐多药,应用利奈唑胺后,患者临床症状逐渐缓解,肺部阴影吸收,脑脊液多次培养均阴性,随访至今,未再复发。结论:利奈唑胺在耐药结核性脑膜炎中可能有较好地应用前景。

Objective： To improve the understanding of the effect of linezolid in the treatment of refractory drug-resistant tuberculous meningitis. Methods： Clinical manifestations, imaging findings, treatment and prognosis of patients with linezolid in the treatment of refractory drug-resistant tuberculous meningitis were reported and the related literatures were reviewed. Results： The patient was a young woman, whose clinical manifestations were fever and headache, the imaging findings showed diffuse shadow of miliary nodules in double lungs and brain, hydrocephalus. Cerebrospinal fluid culture was positive for mycobacterium tuberculosis, and showed multi drug-resistant.After treatment of linezolid, clinical symptoms, including headache, high fever, etc, were all relieved. Abnormality of cerebrospinal fluid was improved. Abnormality lung shadow absorption and CSF cultures were negative for several times. No recurrence was observed. Conclusion： Linezolid could be used effectively in the treatment of patients with refractory drug-resistant tuberculous meningitis.