急性B淋巴细胞白血病与淋巴母细胞淋巴瘤合并产单核李斯特菌感染脑膜炎1例报告

One case report of acute B lymphocytic leukemia and lymphoblastic lymphoma complicated with Listeria monocytogenes infection meningitis

目的报告1例急性B淋巴细胞白血病与淋巴母细胞淋巴瘤合并产单核李斯特菌血流感染及脑膜炎感染经治疗失败的病例,总结经验教训,以提高临床对此类感染的诊治水平。方法曲靖市第二人民医院于2021年5月17日收治1例急性B淋巴细胞白血病/淋巴母细胞淋巴瘤化疗患者,血培养检出产单核细胞李斯特菌,诊断为血源性感染导致细菌性脑膜炎,患者经治疗无效死亡。结果患者为58岁男性,因急性B淋巴细胞白血病/淋巴母细胞淋巴瘤接受VDP方案化疗,2021年4月27日化疗结束后复查骨髓穿刺涂片正常,病情评估为持续完全缓解(CR)出院。5月17日患者因“头痛2 d,发热1 d”再次入院,血培养检出产单核李斯特菌;药敏试验结果显示菌株对复方新诺明、青霉素、美罗培南、氨苄青霉素敏感;脑脊液标本二代基因测序(NGS)检出产单核李斯特菌。诊断为合并产单核细胞李斯特菌血源性感染及李斯特菌脑膜炎,经先后使用青霉素、氨苄青霉素治疗,效果欠佳,患者于5月27日16:33死亡。结论临床针对李斯特菌的治疗首选青霉素、氨苄青霉素,但对李斯特菌脑膜炎患者应考虑到血脑屏障对治疗药物的影响,因此,选择美罗培南联合使用可能会起到更好的治疗效果。

Objective To report a case of acute B lymphocytic leukemia and lymphoblastic lymphoma complicated with Listeria monocytogenes bloodstream infection and meningitis infection,which failed the treatment,and summarize the experiences in the treatment,so as to improve the clinical diagnosis and treatment technique.Methods On May 17,2021,a patient with acute B lymphoblastic leukemia/lymphoblastic lymphoma receiving chemotherapy was admitted in Qujing Second People's Hosipital.Listeria monocytogenes were detected by blood culture test,the patient was diagnosed as blood borne infection leading to bacterial meningitis,and died after treatment.Results The patient was a 58-year-old male who received VDP chemotherapy for acute B-lymphocyte leukemia/lymphoblastic lymphoma.After chemotherapy on April 27,2021,the result of bone marrow biopsy smear was normal,and his condition was evaluated as continuous complete remission(CR).On May 17,the patient was hospitalized again because of"headache for 2 days and fever for 1 day".The blood culture test produced Listeria monocytogenes.The drug sensitivity results showed that the strain was sensitive to Compound Trimethoprim,Penicillin,Meropenem and Ampicillin.Next-generation gene sequencing(NGS)of cerebrospinal fluid samples detected Listeria monocytogenes.The patient was diagnosed with blood borne infection of Listeria monocytogenes and Listeria meningitis,and was treated with Penicillin and Ampicillin successively.The effect was poor,and the patient died at 16:33 on May 27.Conclusions The first choice for the treatment of Listeria is Penicillin and Ampicillin,but for patients with Listeria meningitis,the influence of the blood-brain barrier on therapeutic drugs should be considered.Therefore,choosing to use it in combination with Meropenem will have a better therapeutic effect.