Abstract：
A 3-year-old boy presented with acute headache, vomiting and right focal clonic seizures without history of fever, joint pain or altered sensorium. Neuroimaging showed multifocal contrast enhancing lesions with significant perilesional edema. CECT chest and abdomen showed multiple variable sized nodules in the lungs and hypodense lesion in liver with mesenteric lymphadenopathy. There was persistent eosinophilia with maximum upto 35 %. Liver biopsy and brain biopsy revealed Cladophialophora bantiana. He was treated with IV liposomal amphotericin and voriconazole for 6 weeks with repeat neuroimaging showing more than 50 % resolution of the intracranial lesions. He was transitioned to oral combination of flucytosine and voriconazole. At 14 months follow-up, he remained symptom free with complete radiological resolution of the lesions and no eosinophilia. High suspicion, an aggressive approach in obtaining microbiological diagnosis and timely combination antifungal therapy may give satisfactory outcome without surgery.
摘要：
一名3岁男孩出现急性头痛，呕吐和右侧局灶性阵挛性癫痫发作，无发热史，关节痛或感觉改变。神经影像学显示多灶性对比增强病变并伴有明显的病灶周围水肿。CECT胸部和腹部显示肺部多个可变大小的结节和肝脏低密度病变并肠系膜淋巴结肿大。持续存在嗜酸性粒细胞增多，最高可达35％。肝活检和脑活检显示丁香。他接受了静脉注射脂质体两性霉素和伏立康唑治疗6周，重复神经影像学检查显示颅内病变的分辨率超过50％。他过渡到氟胞嘧啶和伏立康唑的口服组合。在14个月的随访中，他保持无症状，病变的放射学完全消退，没有嗜酸性粒细胞增多。高度怀疑，在获得微生物学诊断和及时联合抗真菌治疗方面采取积极的方法可以在不进行手术的情况下获得令人满意的结果。
