非典型脑囊尾蚴病1例

A case of atypical cerebral cysticercosis

患者,女,55岁,安徽蚌埠人,2021年10月19日因“间断低热、干咳合并脑积水1年余”就诊于复旦大学附属华山医院。该患者1年来反复出现发热,体温37.5~38.0℃,伴阵发性干咳,外院头颅CT检查发现有脑积水,9月28日曾在该院行腹腔镜辅助下脑室腹腔分流术,术后仍有发热、咳嗽。头颅增强MRI示鞍区和基底池内异常强化影,遂收治感染科,行腰穿取脑脊液,送宏基因组二代测序(mNGS),检测到猪带绦虫序列208721条;血清囊尾蚴抗体检测阳性。患者否认食用生肉史,但近2年来曾多次食用未完全清洁的生蔬菜。综合影像学表现、实验室检查、mNGS结果和流行病学史,患者被诊断为“脑囊尾蚴病”。予以阿苯达唑口服驱虫治疗2个疗程,每个疗程服用总量为150 mg/kg,第1疗程12 d,第2疗程8 d,治疗过程中无新发不适。第1疗程结束复查头颅增强MRI示鞍区和基底池内异常强化影,强化程度较前片减轻。第2疗程结束后复查头颅CT示脑积水,侧脑室引流术后改变,脑室扩大程度较前略有减轻,鞍区密度欠均匀。疗程结束外院定期随访。

In October 2021,a 55-year-old female patient from Bengbu,Anhui,was admitted to Huashan Hospital Affiliated to Fudan University with the main complaint of“intermittent low fever,dry cough with hydro-cephalus for more than 1 year”.In the previous year,the patient repeatedly developed fever with a body tempera-ture of 37.5-38.0℃and paroxyresis of dry cough.Head CT examination revealed hydrocephalus,and laparoscopic-assisted ventriculoperitoneal shunt was performed in the hospital on September 28.The fever and cough remained after the operation,and enhanced head MRI showed“abnormal enhancement shadows in the sellar region and basal cistern”.A total number of 208721 copies of Taenia solium sequence was detected in the cerebrospinal fluid based on metagenomic next-generation sequencing(mNGS),and the serum cysticercosis antibody was positive.In the epidemiological history,the patient denied eating raw pork,but had eaten incompletely cleaned raw veg-etables for many times in the past 2 years.Combining imaging findings,laboratory tests and mNGS results,the pa-tient was diagnosed with“cerebral cysticercosis”.The patient then started to take albendazole for two courses,the total amount of each course was 150 mg/kg,the first course lasted for 12 days,and the second course lasted for8 days,and the patient had no noticeable discomfort during the treatment.After the first course of treatment,en-hanced head MRI showed abnormal enhancement shadow in the saddle region and basal cistern,and the enhance-ment degree was less than that of the previous film.The re-examination of the head CT showed hydrocephalus,changes after the lateral ventricular drainage,the extent of ventricular enlargement had slightly reduced,and the den-sity of the saddle area was not uniform.Regular follow-up was undertaken at the end of the course of treatment by other hospitals.