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新型隐球菌脑膜炎较少见,因无特异性临床表现常被误诊,误诊率40％左右,现报我们误诊3例如下。例1,男,41岁,入院前40天全身不适、发烧,头痛渐重,半月来呕吐。他院腰穿发现脑脊液细胞蛋白轻度增高,按炎症冶疗不见好转,曾查头颅CT2次未见异常。入院检查:神清,双眼视乳头水肿,左下肢肌力较好,双Babinski氏征(-),项强一横指,Kernig氏征(-),初诊为颅内占位病变。腰穿压力1.47kPa,潘氏反应(-),WBC 250×10~6/L,多核>单核,墨汁染色镜下可见成堆的有荚膜的新型隐球菌,蛋白0.18g/L,糖2.8mmol/L。给以大蒜液、二性霉素B等治
Cryptococcus neoformans meningitis is rare, because no specific clinical manifestations are often misdiagnosed, misdiagnosis rate of 40%, are reported to our misdiagnosis in 3 cases as follows. Example 1, male, 41 years old, 40 days before admission, general malaise, fever, headache gradually heavier, vomiting half a month. His waist and waist found cerebrospinal fluid cell protein was slightly elevated, according to the inflammation treatment did not improve, had checked the head CT2 times no abnormalities. Admission examination: Shen Qing, binocular papilledema, left lower extremity muscle strength better, double Babinski’s sign (-), Xiangqiang a cross-finger, Kernig’s sign (-), newly diagnosed as intracranial space-occupying lesions. Lumbar puncture pressure 1.47kPa, Pan’s reaction (-), WBC 250 × 10 ~ 6 / L, multicore> mononuclear, ink stain visible stack piles of Cryptococcus neoformans, protein 0.18g / L, sugar 2.8 mmol / L. Give garlic, amphotericin B and other treatment