系统性红斑狼疮并发隐球菌性脑膜炎:1例报告并文献复习

中国真菌学杂志　 2010, Vol. 5 　Issue (4): 223-226.

系统性红斑狼疮并发隐球菌性脑膜炎:1例报告并文献复习

黄晨, 朱元杰, 顾菊林, 温海

第二军医大学长征医院皮肤科, 上海, 200003

收稿日期:2010-05-29 出版日期:2010-08-28 发布日期:2010-08-28
通讯作者: 顾菊林,E-mail:wujgjl@126.com E-mail:wujgjl@126.com
作者简介:黄晨,男(汉族),硕士研究生在读.E-mail:huangchen860416@126.com
基金资助:
国家自然科学基金(30972817)

Cryptococcal meningitis in systemic lupus erythematosus:one case report and literature review

HUANG Chen, ZHU Yuan-jie, GU Ju-lin, WEN Hai

Department of Dermatology, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China

Received:2010-05-29 Online:2010-08-28 Published:2010-08-28

摘要/Abstract

摘要： 目的探讨系统性红斑狼疮(SLE)合并隐球菌性脑膜炎的诊断及鉴别诊断。方法对1例SLE并发隐球菌性脑膜炎患者的临床及实验室检查特点进行分析,并结合文献复习进行讨论。结果患者出现中枢感染前长期使用泼尼松治疗,曾误诊为狼疮脑病应用激素冲击治疗无效;治疗过程中出现狼疮活动,激素加量后症状缓解。结论 SLE并发隐球菌性脑膜炎患者的临床表现缺乏特异性,感染相关症状与SLE表现部分重叠,腰穿脑脊液墨汁染色找隐球菌和隐球菌抗原乳胶凝集试验是诊断的主要手段。及时诊断和有效抗真菌治疗可改善患者的预后。

关键词: 红斑狼疮,系统性, 隐球菌性脑膜炎, 狼疮脑病

Abstract: Objective To investigate the diagnosis and discrimination of systemic lupus erythematosus(SLE)complicated with cryptococcal meningitis.Methods One case of cryptococcal meningitis in SLE was reported and related literature was reviewed.Results The patient was treated by prednisone for a long time before central nervous system infection and misdiagnosed as a neuropsychiatric manifestation of SLE when she failed to respond to shock corticosteroid therapy.Lupus activity occurred during antifungal therapy.The symptoms were relieved after corticosteroid dosage increasing.Conclusions As the clinical findings of SLE patients with cryptococcal meningitis are non-specific and misleading,CSF India ink stain and latex agglutination test for cryptococcal antigen should be performed which effective to establish an early diagnosis.Timely diagnosis and antifungal therapy could improve the prognosis of cryptococcal meningitis in SLE patients.

Key words: systemic lupus erythematosus, cryptococcal meningitis, neuropsychiatric SLE

中图分类号:

R593.241

黄晨, 朱元杰, 顾菊林, 温海. 系统性红斑狼疮并发隐球菌性脑膜炎:1例报告并文献复习[J]. 中国真菌学杂志, 2010, 5(4): 223-226.

HUANG Chen, ZHU Yuan-jie, GU Ju-lin, WEN Hai. Cryptococcal meningitis in systemic lupus erythematosus:one case report and literature review[J]. Chinese Journal of Mycology, 2010, 5(4): 223-226.

参考文献

[1] Gladman DD,Hussain F,Ibanez D.The nature and outcome of infection in systemic lupus erythematosus[J] Lupus,2002,11(4):234-239.
[2] Ginzler EM,Diamond HS,Weiner M.A multicenter study of outcome in systemic lupus erythematosus.I.Entry variables as predictors of pragnosis[J] Arthritis Rheum,1982,25(6):601-611.
[3] Fessler BJ.Infectious diseases in systemic lupus erythematesus:risk factors,management and prophylaxis[J] Best Pract Res Clin Rheumatol,2002,16(2):281-291.
[4] Khalifa M,Kaabia N,Bahri F.Infection in systemic lupus erythematusus[J] Med Mal Infect,2007,37(12):792-795.
[5] Al-Rayes H,Al-Swailem R,Arfin M.Systemic lupus erythematesus and infections:a retrospective study in Sandis[J] Lupus,2007,16(9):755-763.
[6] 詹钟平,梁柳琴,陈冬莹,等.系统性红斑狼疮合并医院内真菌感染的病原学分析与治疗[J] 中国药物与临床,2008,8(9):699-701.
[7] Kim HJ,Park YJ,Kim WU.lnvasive fungal infections inpatients with systemic lupus erythematosus:experience from affilinted hospitals of Catholic University of Korda[J] Lupus,2009,18(7):661-666.
[8] Chen HS,Tasi WP,Leu HS.Invasive fungul infection in systemic lupus erythematosus:an analysis of 15 cases and a literature review[J] Rheumatology(Oxford),2007,46(3):539-544.
[9] Hung JJ,Ou LS,Lee WI.Central nervous system infections in patients with systemic lupus erythematosus[J] J Rheumatol,2005,32(1):40-43.
[10] Yang CD,Wang XD,Ye S.Clinical features,prognostic and risk factors of central nervous system infections in patients with systemic lupus erythematosus[J] Clin Rheumatol,2007,26(6):895-901.
[11] VargusPJ,King G,Navarra SV.Central nervous system infections in Filipino patients with systemic lupus erythematusus[J] Int J Rheum Dis,2009,12(3):234-238.
[12] Ng WL,Chu CM,Wu AK.Lymphopenia at presentation is associated with increased risk of infections in patients with systemic lupus erythematosus[J] QJM,2006,99(1):37-47.
[13] Bosch X,Guilabert A,Pallarés L.Infections in systemic lupus erythematosus:a prospective and controlled study of 110patients[J] Lupus,2006,15(9):584-589.
[14] 鲍春德,季宏,顾越英,等.系统性红斑狼疮合并隐球菌脑膜炎-附二例报道及文献复习[J] 中华风湿病学杂志,1999,3(1):23-26.
[15] Zimmerman B,Spiegel M,Lally EV.Cryptococcal meningitis in systemic lupus erythematosus[J] Semin Arthritis Rheum,1992,22(1):18-24.
[16] 王颖莲.系统性红斑狼疮合并新型隐球菌性脑膜炎一例[J] 内蒙古医学杂志,2009,41(5):528.
[17] 吕良敬,陆方林,鲍春德,等.系统性红斑狼疮合并隐球菌性脑膜炎临床分析[J] 中国临床医学,2006,13(1):134-135.
[18] González LA,Vásquez G,Restrepo JP.Cryptococcosis in systemic lupus erythematosus:a series of six cases[J] Lupus,2010,19(5):639-645.
[19] Perfect JR,Dismukes WE,Dromer F.Clinical practice guidelines for the management of cryptococcal disease:2010 update by the Infectious Diseases Society of America[J] Clin Infect Dis,2010,50(3):291-322.
[20] 中国真菌学杂志编辑委员会.隐球菌感染诊治专家共识[J] 中国真菌学杂志,2010,5(2):65-68.
[21] 沈银忠,卢洪洲.齐唐凯,等.两性霉素B联合氟胞嘧啶与伏立康唑治疗艾滋病合并隐球菌脑膜炎的临床回顾性研究[J] 中国真菌学杂志,2009,4(6):338-342.