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Abstract：
BACKGROUND: Central nervous system (CNS) aspergillosis has the characteristics of multifocality, polymorphism, and coexistence of pathological types, and missed diagnosis and misdiagnosis frequently occur at the initial stage. The thesis reports a rare case of infant infection of CNS aspergillosis with the first-episode of intracranial hemorrhage.
METHODS: An 11-month-old female infant suffered convulsion and coma two days after the onset of fever and emesis. Its cranial computed tomography (CT) displayed subdural hemorrhage in the left tentorium cerebelli and tests indicated normal cerebrospinal fluid (CSF). Three days after being hospitalized, the infant had difficulty breathing and its CT presents consolidation in the right lung. However, treatment with ceftriaxone (ivgtt) had no effect on the baby.
METHODS: The patient\'s bronchoalveolar lavage fluid (BALF) was cultured into Aspergillus spp, its galactomannan (GM) antigen in CSF counted 3.0, higher than that in BALF which counted 2.6, and cranial magnetic resonance imaging (MRI) revealed multiple ring reinforced tubercles in sulci. Hence it was clinically diagnosed with CNS aspergillosis.
METHODS: Voriconazole for intravenous injection. After the intravenous injection, its trough concentration was 4.2 μg/mL, and it was within the recommended range.
RESULTS: After one week\'s treatment with voriconazole, the infant\'s consciousness was improved. Four weeks later, with normothermia and clear consciousness, the patient was discharged. With oral administration of voriconazole up to 16 weeks, its physical state suggests no relapse and cranial MRI indicated disappearance of nodules in sulci.
CONCLUSIONS: CNS aspergillosis with first-episode of intracranial hemorrhage probably leads to misdiagnosis and GM test combined with cranial MRI can augment its accuracy in the early diagnosis.
METHODS: An 11-month-old female infant suffered convulsion and coma two days after the onset of fever and emesis. Its cranial computed tomography (CT) displayed subdural hemorrhage in the left tentorium cerebelli and tests indicated normal cerebrospinal fluid (CSF). Three days after being hospitalized, the infant had difficulty breathing and its CT presents consolidation in the right lung. However, treatment with ceftriaxone (ivgtt) had no effect on the baby.
METHODS: The patient\'s bronchoalveolar lavage fluid (BALF) was cultured into Aspergillus spp, its galactomannan (GM) antigen in CSF counted 3.0, higher than that in BALF which counted 2.6, and cranial magnetic resonance imaging (MRI) revealed multiple ring reinforced tubercles in sulci. Hence it was clinically diagnosed with CNS aspergillosis.
METHODS: Voriconazole for intravenous injection. After the intravenous injection, its trough concentration was 4.2 μg/mL, and it was within the recommended range.
RESULTS: After one week\'s treatment with voriconazole, the infant\'s consciousness was improved. Four weeks later, with normothermia and clear consciousness, the patient was discharged. With oral administration of voriconazole up to 16 weeks, its physical state suggests no relapse and cranial MRI indicated disappearance of nodules in sulci.
CONCLUSIONS: CNS aspergillosis with first-episode of intracranial hemorrhage probably leads to misdiagnosis and GM test combined with cranial MRI can augment its accuracy in the early diagnosis.
摘要：
背景：中枢神经系统（CNS）曲霉病具有多灶性的特征，多态性,病理类型共存，初期常发生漏诊和误诊。本文报道了一例罕见的婴儿中枢神经系统曲霉病感染并首次颅内出血的病例。
方法：一名11个月大的女婴在发热和呕吐后两天出现抽搐和昏迷。其头颅计算机断层扫描（CT）显示左小脑幕硬膜下出血，测试显示脑脊液（CSF）正常。住院三天后，婴儿呼吸困难,CT显示右肺实变.然而,头孢曲松（ivgtt）治疗对婴儿没有影响。
方法：将患者的支气管肺泡灌洗液（BALF）培养到曲霉属，脑脊液中半乳甘露聚糖（GM）抗原计数为3.0，高于BALF中的2.6，颅磁共振成像（MRI）显示沟中有多个环形增强结节。因此，临床诊断为中枢神经系统曲霉病。
方法：伏立康唑静脉注射。静脉注射后,其谷浓度为4.2μg/mL，它在建议的范围内。
结果：伏立康唑治疗一周后，婴儿的意识得到了改善。四周后,具有正常的体温和清晰的意识，病人出院了。口服伏立康唑长达16周，其身体状态提示无复发，头颅MRI提示沟结节消失。
结论：中枢神经系统曲霉病合并首次颅内出血可能会导致误诊，GM检测联合头颅MRI可提高其早期诊断的准确性。
方法：一名11个月大的女婴在发热和呕吐后两天出现抽搐和昏迷。其头颅计算机断层扫描（CT）显示左小脑幕硬膜下出血，测试显示脑脊液（CSF）正常。住院三天后，婴儿呼吸困难,CT显示右肺实变.然而,头孢曲松（ivgtt）治疗对婴儿没有影响。
方法：将患者的支气管肺泡灌洗液（BALF）培养到曲霉属，脑脊液中半乳甘露聚糖（GM）抗原计数为3.0，高于BALF中的2.6，颅磁共振成像（MRI）显示沟中有多个环形增强结节。因此，临床诊断为中枢神经系统曲霉病。
方法：伏立康唑静脉注射。静脉注射后,其谷浓度为4.2μg/mL，它在建议的范围内。
结果：伏立康唑治疗一周后，婴儿的意识得到了改善。四周后,具有正常的体温和清晰的意识，病人出院了。口服伏立康唑长达16周，其身体状态提示无复发，头颅MRI提示沟结节消失。
结论：中枢神经系统曲霉病合并首次颅内出血可能会导致误诊，GM检测联合头颅MRI可提高其早期诊断的准确性。
