IF 1.1 Q4 INFECTIOUS DISEASES

IDCases

Pub Date : 2025-01-01 DOI: 10.1016/j.idcr.2025.e02293

Oulfa Boussetta-Charfi , François Duprey , Rémi Balluet , Marie-France Lutz , Sylvie Gonzalo , Anne-Camille Faure , Annie Evers , Sara Chenafi-Adham , Elisabeth Botelho-Nevers , Guillaume Dupont , Thomas Bourlet , David Boutolleau , Sylvie Pillet

Herpes simplex virus (HSV)-associated hepatitis (HH) has rarely been reported in immunocompetent patients. In the absence of mucocutaneous lesions and because of nonspecific biological features such as hepatic cytolysis, its diagnosis can be missed, leading to delayed acyclovir initiation and potentially poor outcomes. We report a case of a 62-year-old immunocompetent man who developed severe HH following a primary HSV-1 infection, diagnosed by a very high plasma HSV-1 DNA load. His condition was complicated by macrophage activation syndrome, which was managed using chemotherapy and corticosteroids. Acyclovir therapy (10 mg/kg every 8 ,h) was extended to Day 74 to a persistently detectable plasma HSV-1 DNA load, despite the normalisation of liver function tests. However, the optimal duration of antiviral therapy for HH remains unclear, as prolonged treatment may increase the risk of nephrotoxicity, whereas premature discontinuation may lead to fatal outcomes. Overall, this case illustrates that discontinuation of acyclovir did not result in a rebound of HSV-1 viraemia despite the persistent detection of low viral DNA load. Clinical and biological resolution of hepatitis may be helpful in guiding the decision to discontinue antiviral therapy. This case highlights the importance of early molecular diagnosis in atypical presentations of HH and contributes to guiding management strategies, particularly regarding antiviral treatment duration.

单纯疱疹病毒（HSV）相关肝炎（HH）在免疫功能正常的患者中很少报道。在没有粘膜皮肤病变的情况下，由于肝细胞溶解等非特异性生物学特征，其诊断可能会被遗漏，导致阿昔洛韦起始治疗延迟和潜在的不良预后。我们报告一个62岁的免疫功能正常的人谁发展严重HH后，原发HSV-1感染，诊断为非常高的血浆HSV-1 DNA负荷。他的病情并发巨噬细胞激活综合征，使用化疗和皮质类固醇治疗。阿昔洛韦治疗（10 mg/kg每8 ，h）延长至第74天，持续检测血浆HSV-1 DNA负荷，尽管肝功能测试已恢复正常。然而，HH抗病毒治疗的最佳持续时间仍不清楚，因为延长治疗可能增加肾毒性的风险，而过早停止治疗可能导致致命的结果。总的来说，该病例表明，尽管持续检测到低病毒DNA载量，停用阿昔洛韦并未导致HSV-1病毒血症的反弹。肝炎的临床和生物学解决可能有助于指导决定停止抗病毒治疗。该病例强调了早期分子诊断在HH非典型表现中的重要性，并有助于指导管理策略，特别是关于抗病毒治疗的持续时间。

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引用次数: 0

H1N1-associated acute leukoencephalopathy: An unusual presentation in a young adult indian male 甲型h1n1流感相关的急性脑白质病：一个不寻常的表现在年轻的成年印度男性

IF 1.1 Q4 INFECTIOUS DISEASES

IDCases

Pub Date : 2025-01-01 DOI: 10.1016/j.idcr.2025.e02312

Sharvari Joshi , Aparna Pai , Muralidhar Varma

The H1N1 virus commonly causes symptoms such as fever, cough, sore throat, which have a self-limited course in most cases. Neurological complications are rare, especially in adults. This case illustrates H1N1-associated acute leukoencephalopathy in a young adult with a favorable outcome and no lasting neurological deficits. The initial presentation included fever, sore throat, and myalgia, evolving into neurological symptoms, including dysarthria, nystagmus, and left-sided motor weakness. Comprehensive laboratory tests ruled out common bacterial, viral, or autoimmune causes, while MRI findings suggested acute leukoencephalopathy of infectious or toxic etiology. Although the urine toxicology screen showed traces of phenol, clinical evidence did not correlate with toxic exposure and pointed towards an infectious origin. A throat swab for Influenza/H1N1 PCR confirmed the diagnosis. Treatment with oseltamivir and methylprednisolone led to symptomatic improvement with no sequelae.

H1N1病毒通常会引起发烧、咳嗽、喉咙痛等症状，在大多数情况下，这些症状会自行消退。神经系统并发症很少见，尤其是在成人中。这个病例说明了h1n1相关的急性脑白质病在一个年轻的成年人有一个良好的结果，没有持久的神经功能障碍。最初表现为发热、喉咙痛和肌痛，逐渐发展为神经系统症状，包括构音障碍、眼球震颤和左侧运动无力。综合实验室检查排除了常见的细菌、病毒或自身免疫性原因，而MRI结果提示感染性或毒性急性脑白质病。尽管尿液毒理学检查显示有苯酚的痕迹，但临床证据与毒性暴露无关，并指向感染来源。咽拭子流感/H1N1聚合酶链反应证实了诊断。用奥司他韦和甲基强的松龙治疗导致症状改善，无后遗症。

引用次数: 0

Tuberculosis of seminal vesicles: a rare case report 精囊结核一例罕见报告

IF 1.1 Q4 INFECTIOUS DISEASES

IDCases

Pub Date : 2025-01-01 DOI: 10.1016/j.idcr.2025.e02288

Hicham El Boté , Abdelmounim BOUGHALEB

Tuberculosis of seminal vesicles is an uncommon form of genitourinary tuberculosis, frequently presenting with nonspecific symptoms and posing diagnostic challenges. Herein is reported a case of a 33-year-old male with a history of pulmonary tuberculosis in childhood who presented with nonspecific urinary symptoms. Imaging and histopathological findings confirmed tuberculosis of the seminal vesicle. This case underscores the importance of considering tuberculosis in the differential diagnosis of genitourinary symptoms, especially in patients with a prior history of tuberculosis. Early diagnosis and timely treatment are important to prevent complications and improve outcomes.

精囊结核是泌尿生殖系统结核的一种罕见形式，经常表现为非特异性症状，并提出诊断挑战。本文报告一例33岁男性，儿童期有肺结核病史，表现为非特异性尿路症状。影像及病理检查证实精囊结核。本病例强调了在泌尿生殖系统症状的鉴别诊断中考虑结核病的重要性，特别是在有结核病病史的患者中。早期诊断和及时治疗对于预防并发症和改善预后非常重要。

引用次数: 0

Ethical use of AI in infectious diagnostic decision and therapeutic stewardship 人工智能在传染病诊断决策和治疗管理中的伦理应用

IF 1 Q4 INFECTIOUS DISEASES

IDCases

Pub Date : 2025-01-01 DOI: 10.1016/j.idcr.2025.e02356

Prasan Kumar Panda, Sukanya Ghosh

Artificial intelligence (AI) is rapidly reshaping healthcare, offering transformative potential in infectious diagnostics and antimicrobial stewardship through enhanced accuracy, efficiency, and predictive capabilities. However, its integration into clinical practice raises significant ethical challenges. These include transparency of decision-making, protection of patient privacy, algorithmic fairness, accountability, and the preservation of human oversight. Global and national bodies have developed guidance to address these concerns: the World Health Organization (WHO) emphasizes autonomy, inclusiveness, and equity; the U.S. Food and Drug Administration (FDA) regulates adaptive AI as medical devices; the European Union AI Act classifies medical AI as “high-risk”; and the Indian Council of Medical Research (ICMR) highlights accountability, data security, and cultural sensitivity. Drawing on these frameworks, this perspective discusses the ethical imperatives of deploying AI responsibly in infectious diagnostic and therapeutic stewardship. Best practices are outlined to ensure that innovation enhances patient trust, safety, and equity while mitigating risks of misuse or bias.

人工智能（AI）正在迅速重塑医疗保健，通过提高准确性、效率和预测能力，在感染诊断和抗菌药物管理方面具有变革性潜力。然而，将其整合到临床实践中会引发重大的伦理挑战。其中包括决策的透明度、患者隐私的保护、算法的公平性、问责制和维护人类监督。全球和国家机构制定了解决这些关切的指导方针：世界卫生组织（世卫组织）强调自主、包容和公平；美国食品和药物管理局（FDA）将自适应人工智能作为医疗设备进行监管；欧盟人工智能法案将医疗人工智能列为“高风险”；印度医学研究委员会（ICMR）强调问责制、数据安全和文化敏感性。利用这些框架，本观点讨论了在传染病诊断和治疗管理中负责任地部署人工智能的伦理必要性。本文概述了最佳实践，以确保创新增强患者的信任、安全和公平，同时减轻滥用或偏见的风险。

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引用次数: 0

A case of brucellosis with perinephritis presented as abdominal and low back pain in China 布鲁氏菌病合并肾炎1例，表现为腹部和下背部疼痛

IF 1 Q4 INFECTIOUS DISEASES

IDCases

Pub Date : 2025-01-01 DOI: 10.1016/j.idcr.2025.e02372

Hang Li , Xiang Gao , Zi-yang Li , Xia Xu , Jian-ping Chen

Background

Human brucellosis, a zoonotic infection, typically manifests as fever, fatigue, anorexia, and osteoarticular pain. We report a rare case of brucellosis complicated by perinephritis, presenting with abdominal and low back pain.

Case presentation

A 74-year-old male presented with fever, abdominal and low back pain. Initial lumbar magnetic resonance imaging (MRI) demonstrated L4–5 disc herniation with foraminal and spinal canal stenosis, while abdominal computed tomography (CT) revealed perinephric inflammation without structural abnormalities. Upon developing intermittent fever (38 °C), epidemiological history uncovered chronic consumption of uninspected sheep meat. Brucellosis with perinephritis was confirmed via supportive Brucella agglutination test and blood culture.

Conclusions

Perinephritis is an uncommon complication of brucellosis, and atypical abdominal pain warrants consideration of zoonotic exposure. Serological testing (agglutination test) and blood culture remain critical for timely diagnosis in high-risk patients.

人类布鲁氏菌病是一种人畜共患感染，典型表现为发热、疲劳、厌食和骨关节疼痛。我们报告一个罕见的病例布鲁氏菌病并发肾炎，表现为腹部和下背部疼痛。病例表现男性，74岁，表现为发热、腹部和腰痛。最初的腰椎磁共振成像（MRI）显示L4-5椎间盘突出伴椎间孔和椎管狭窄，而腹部计算机断层扫描（CT）显示肾周炎症，无结构异常。在出现间歇性发热（38°C）时，流行病学史发现长期食用未经检查的羊肉。通过支持性布鲁氏菌凝集试验和血培养证实布鲁氏菌病伴会阴炎。结论腹膜肾炎是布鲁氏菌病的罕见并发症，不典型腹痛值得考虑人畜共患暴露。血清学检测（凝集试验）和血培养对高危患者的及时诊断仍然至关重要。

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引用次数: 0

Nasopharyngeal swab for the diagnosis of SARS-CoV-2 (COVID-19) infection complicated by severe pneumococcal meningitis 鼻咽拭子诊断SARS-CoV-2 （COVID-19）感染合并严重肺炎球菌脑膜炎

IF 1 Q4 INFECTIOUS DISEASES

IDCases

Pub Date : 2025-01-01 DOI: 10.1016/j.idcr.2025.e02381

Comlan Affo , Jeanne Tisseau des Escotais , Antoine Bosquet , Isabelle Mahé

The nasopharyngeal swab is the reference test for diagnosing coronavirus disease 2019 (COVID-19) and other respiratory pathogens. Although this procedure appears to be risk free and was performed thousands of times daily during peaks of the COVID-19 pandemic, as well as during influenza and bronchiolitis outbreaks, it can be associated with minor to serious risks. These range from simple epistaxis to breaches of the meninges and skull stalks. Some breaches occur in the presence of anomalies such as congenital, traumatic or surgical encephaloceles. Neuro-meningeal breaches can be complicated by bacterial infections. We report the case of a 57-year-old woman diagnosed with Streptococcus pneumoniae meningitis following a nasopharyngeal swab for reverse transcription polymerase chain reaction testing. She had been experiencing cerebrospinal fluid leakage for 1 year after a nasopharyngeal swab performed on an unidentified encephalocele. Antibiotic treatment followed by surgical repair of the encephalocele led to full recovery. Although nasopharyngeal swab tests seem simple, clear instructions are essential for both sample collectors and patients, and any complication, even minor, must be carefully considered. Bacterial meningitis is a serious disease that can cause death or irreversible neurological sequelae. The presence of clear fluid flow after a nasopharyngeal swab should prompt investigation for a meningeal breach. Detecting such a breach may reveal a pre-existing or newly formed malformation, allowing for specialized care to prevent severe complications such as meningitis.

鼻咽拭子是诊断2019冠状病毒病（COVID-19）和其他呼吸道病原体的参考检测。尽管该手术似乎无风险，并且在2019冠状病毒病大流行高峰期以及流感和细支气管炎暴发期间每天进行数千次，但它可能与轻微至严重的风险相关。其范围从简单的鼻出血到脑膜和颅骨柄的破裂。有些裂口发生在先天性、外伤性或手术性脑膨出等异常情况下。神经-脑膜破裂可因细菌感染而复杂化。我们报告的情况下，57岁的妇女诊断为肺炎链球菌脑膜炎后鼻咽拭子逆转录聚合酶链反应测试。她在对不明脑膨出进行鼻咽拭子检查后出现脑脊液漏1年。抗生素治疗后手术修复脑膨出导致完全恢复。虽然鼻咽拭子测试似乎很简单，但对于样本收集者和患者来说，明确的说明是必不可少的，任何并发症，即使是轻微的，都必须仔细考虑。细菌性脑膜炎是一种严重的疾病，可导致死亡或不可逆转的神经系统后遗症。鼻咽拭子检查后出现清晰的液体流，应提示检查是否有脑膜破裂。检测到这样的裂口可能会发现先前存在的或新形成的畸形，从而允许进行专门护理，以防止严重的并发症，如脑膜炎。

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引用次数: 0

Hemorrhagic shock and encephalopathy syndrome with hyper-inflammation and elevation of IL-6 and GDF-15 following COVID-19: A case report 新冠肺炎并发高炎症、IL-6、GDF-15升高的失血性休克脑病综合征1例

IF 1 Q4 INFECTIOUS DISEASES

IDCases

Pub Date : 2025-01-01 DOI: 10.1016/j.idcr.2025.e02390

Yoshinori Yokono , Takeshi Ebihara , Shinya Onishi , Yusuke Takahashi , Hisatake Matsumoto , Kentaro Shimizu , Satoshi Kutsuna , Jun Oda

Hemorrhagic shock and encephalopathy syndrome (HSES) is a life-threatening condition predominantly reported in children and often associated with viral infections such as influenza. We describe a case of HSES in a 21-year-old woman following Coronavirus disease-2019 (COVID-19) infection. She presented with a sore throat, nocturnal chills, and arthralgia one day before admission. On the day of admission, she developed fever and dyspnea and contacted emergency services. Upon arrival, her Glasgow Coma Scale score was E1V1M1 with tachycardia and hypotension. Tachycardia, hypotension, and lactate elevation persisted throughout the early phase of hospitalization. Orotracheal intubation and mechanical ventilation were initiated. Computed tomography revealed no intracranial lesions or pneumonia. A COVID-19 antigen test was positive, and cerebrospinal fluid analysis showed no meningitis. Despite intensive care, shock persisted with critical coagulopathy. Hemodynamic stabilization was achieved with vasopressors and fresh frozen plasma. On day 2, mydriasis developed, and head computed tomography revealed severe cerebral edema and extensive low-density areas consistent with HSES. Despite the administration of steroids and supportive care, the patient died on day 17. The patient’s interleukin-6 (IL-6) and growth differentiation factor (GDF)-15 levels were markedly elevated, with IL-6 peaking at 37,489 ng/mL and GDF-15 at 19,936 pg/mL, exceeding levels observed in other COVID-19 cases at our institution. HSES following COVID-19 infection can progress rapidly, accompanied by marked inflammatory cytokine elevation. Rapid onset of consciousness disorder, coagulopathy, and IL-6 elevation in COVID-19 or other viral infections should raise suspicion for HSES. Early recognition may aid in understanding its pathogenesis and guiding clinical care.

出血性休克和脑病综合征（HSES）是一种危及生命的疾病，主要发生在儿童中，通常与流感等病毒感染有关。我们描述了一名21岁女性在冠状病毒病-2019 （COVID-19）感染后出现HSES的病例。入院前1天出现喉咙痛、夜间发冷和关节痛。入院当天，她出现发烧和呼吸困难，并联系了急救中心。到达时，格拉斯哥昏迷评分为E1V1M1，伴有心动过速和低血压。心动过速、低血压和乳酸升高在住院早期持续存在。开始气管插管和机械通气。计算机断层扫描未发现颅内病变或肺炎。新冠病毒抗原检测呈阳性，脑脊液分析未发现脑膜炎。尽管进行了重症监护，但休克持续存在并伴有严重凝血功能障碍。血管加压剂和新鲜冷冻血浆使血流动力学稳定。第2天，出现瞳孔肿大，头部计算机断层扫描显示严重的脑水肿和广泛的低密度区，与HSES相符。尽管给予类固醇和支持性护理，患者仍于第17天死亡。患者的白细胞介素-6 （IL-6）和生长分化因子(GDF)-15水平明显升高，IL-6峰值为37,489 ng/mL， GDF-15峰值为19,936 pg/mL，超过了本院其他COVID-19病例的水平。COVID-19感染后的HSES进展迅速，伴有明显的炎症细胞因子升高。在COVID-19或其他病毒感染中，意识障碍、凝血功能障碍和IL-6升高的快速发作应引起对HSES的怀疑。早期识别有助于了解其发病机制，指导临床护理。

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引用次数: 0

Radiation recall reactions triggered by COVID-19 infection in a patient with buccal cancer; A clinical report and review of the literature 1例口腔癌患者COVID-19感染引发的辐射回忆反应临床报告及文献回顾

IF 1 Q4 INFECTIOUS DISEASES

IDCases

Pub Date : 2025-01-01 DOI: 10.1016/j.idcr.2025.e02392

Yuto Takada , Hiroshi Doi , Yuko Kinoshita , Miku Kawaguchi , Yukino Numata , Akifumi Enomoto

A case of a patient who developed a radiation recall reaction (RRR) triggered by coronavirus disease 2019 (COVID-19) infection following surgery and chemoradiotherapy for carcinoma of the buccal mucosa is reported. A 75-year-old woman presented in October 2023 with pyrexia and erythema extending from the left cheek to the anterior chest area. In December 2021, she had undergone surgery to remove a carcinoma of the left buccal mucosa (pT2N0M0), followed by left comprehensive neck dissection for delayed cervical lymph node metastasis in June 2022, with subsequent adjuvant chemoradiotherapy. Her course was uneventful until September 2023, when she developed COVID-19. Twenty-three days after COVID-19 infection had been confirmed, she developed systemic pyrexia with erythema and a heat sensation from her left cheek to the left anterior chest. On presentation, her temperature was 39 ºC, and she had a mild sore throat. Erythema and a heat sensation were apparent from the left cheek to the neck and anterior chest, corresponding to the previously irradiated area. Laboratory tests showed a white blood cell count of 11,760/μl, and C-reactive protein of 16.0 mg/dl. Computed tomography did not show any obvious abscess formation or infection source. An RRR was diagnosed, and she was admitted for treatment with intravenous sulbactam/ampicillin and intravenous hydrocortisone sodium succinate. Five days after admission, the inflammatory reaction had improved, and she was discharged. Her subsequent course has been uneventful, with no flareup of the RRR. This case is presented along with a review of relevant literature.

报道1例口腔黏膜癌手术放化疗后发生2019冠状病毒病（COVID-19）感染引发的放射回忆反应（RRR）。一名75岁女性，于2023年10月出现发热和红斑，从左脸颊延伸到胸部前部。2021年12月，患者行左侧颊粘膜癌（pT2N0M0）手术切除，2022年6月行左侧全面颈部清扫术治疗迟发性颈淋巴结转移，随后行辅助放化疗。直到2023年9月，她患上了COVID-19。确诊COVID-19感染后23天，患者出现全身发热伴红斑，从左脸颊到左前胸有热感。就诊时，患者体温39℃，伴有轻度喉咙痛。从左脸颊到颈部和胸部前部，与先前照射的区域相对应，有明显的红斑和热感。实验室检查显示白细胞计数11,760/μl， c反应蛋白16.0 mg/dl。计算机断层扫描未见明显脓肿形成或感染源。她被诊断为RRR，并接受静脉注射舒巴坦/氨苄西林和静脉注射氢化可的松琥珀酸钠治疗。入院5天后，炎症反应好转，出院。她随后的行动平淡无奇，存款准备金率没有大幅上升。本案例与相关文献的回顾一起提出。

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引用次数: 0

False-positive treponemal syphilis serology linked to EBV-related heterophile antibodies: Insights from a multi-platform diagnostic 假阳性梅毒螺旋体血清学与ebv相关的异性恋抗体相关：来自多平台诊断的见解

IF 1 Q4 INFECTIOUS DISEASES

IDCases

Pub Date : 2025-01-01 DOI: 10.1016/j.idcr.2025.e02403

Mengjie Luo, Yi Wu, Qiling Lin, Chunlei Zhang

Background

Syphilis serological false positives associated with interference from heterophile antibodies induced by Epstein–Barr virus (EBV) remain rarely reported. This report aims to document a rare case of syphilis serology discordance ultimately attributed to EBV infection, imitating syphilis serology.

Case Presentation

A 34-year-old woman presented with facial skin lesions and underwent syphilis screening. Initial testing revealed reactive Treponema pallidum (T. pallidum) antibody (TP-Ab), positive T. pallidum particle agglutination assay (TPPA), and negative toluidine red unheated serum test (TRUST). Subsequent testing, including chemiluminescent platforms, immunofluorescence (FTA-ABS), Western blot, and colloidal gold methods, was non-reactive. Comprehensive workup for autoimmune and endocrine disorders was unremarkable. Further investigation revealed elevated antiphospholipid antibodies and positive EBV serologies. EBV DNA was detected. After heterophilic antibody blocking, TPPA and TP-Ab returned to negative, confirming false-positive results.

Conclusion

This case illustrates that heterophile antibody interference can simultaneously affect both particle agglutination and chemiluminescence-based treponemal assays, leading to false-positive results. It emphasizes the necessity of interpreting serological findings in conjunction with clinical history and, when appropriate, confirmatory molecular testing, in order to prevent misdiagnosis and unnecessary treatment.

背景：梅毒血清学假阳性与eb病毒（EBV）诱导的嗜异性抗体干扰相关的报道很少。本报告旨在记录一例罕见的梅毒血清学不一致，最终归因于EBV感染，模仿梅毒血清学。一例34岁女性，因面部皮肤病变接受梅毒筛查。初步检测显示梅毒螺旋体（T. pallidum）抗体（TP-Ab）反应性，梅毒螺旋体颗粒凝集试验（TPPA）阳性，甲苯胺红无热血清试验（TRUST）阴性。随后的测试，包括化学发光平台，免疫荧光（FTA-ABS）， Western blot和胶体金方法，无反应。自身免疫和内分泌疾病的综合检查无显著差异。进一步调查显示抗磷脂抗体升高和EBV血清学阳性。检测EBV DNA。经异源性抗体阻断后，TPPA和TP-Ab恢复为阴性，证实假阳性结果。结论本病例表明，嗜异性抗体干扰可同时影响颗粒凝集和基于化学发光的密螺旋体检测，导致假阳性结果。它强调必须结合临床病史解释血清学结果，并在适当时进行确证性分子检测，以防止误诊和不必要的治疗。

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引用次数: 0

Ophthalmoplegia and vision loss in extrapulmonary tuberculosis with bilateral cavernous sinus involvement 累及双侧海绵窦的肺外结核伴眼麻痹及视力丧失

IF 1 Q4 INFECTIOUS DISEASES

IDCases

Pub Date : 2025-01-01 DOI: 10.1016/j.idcr.2025.e02386

Bilal Hassouneh , Francesco Genderini , Joachim G. Schulz , Stelianos Kampouridis , François Willermain , Tom Buelens

We report the case of a 41-year-old woman who initially presented with headache, right hemifacial hypoesthesia, and a right abducens palsy. Initial external investigations failed to identify an etiology, and cerebral MRI was considered normal, although later review revealed subtle meningeal thickening. Approximately two months later, she developed a right pupil-involving oculomotor nerve palsy, followed by progressive visual loss in the right eye, a right inferior quadrantanopia, and a left abducens palsy. Repeat MRI demonstrated a new contrast-enhancing lesion in the right cavernous sinus, vasculitis involving the intracavernous segment of the left internal carotid artery, FLAIR hyperintensity involving the optic chiasm and left optic tract, and dural thickening with contrast enhancement consistent with pachymeningitis. Tuberculosis was suspected based on a positive QuantiFERON-TB Gold test. Cerebrospinal fluid analysis showed mild lymphocytic pleocytosis but was negative for Mycobacterium tuberculosis (M. tuberculosis) by staining, culture, and PCR. Chest imaging was normal; however, 18F-FDG PET-CT identified a hypermetabolic iliac lymph node. Excision revealed epithelioid cell granulomas with caseous necrosis, and PCR testing (Xpert MTB/RIF Ultra) detected M. tuberculosis, confirmed by culture as drug-sensitive. The patient was treated with a four-drug antitubercular regimen combined with corticosteroids, leading to clinical improvement. She experienced neurological worsening during corticosteroid tapering, which resolved after dose escalation. Cavernous sinus involvement is a rare manifestation of tuberculosis, typically occurring without pulmonary disease and with nonspecific imaging or CSF findings. High clinical suspicion is essential, and identification of an accessible extracranial biopsy site may enable definitive diagnosis while avoiding invasive neurosurgical procedures.

我们报告的情况下，一个41岁的妇女谁最初提出头痛，右半面感觉减退，和右外展肌麻痹。最初的外部检查未能确定病因，大脑MRI被认为是正常的，尽管后来复查显示轻微的脑膜增厚。大约两个月后，她出现了右眼瞳孔累及动眼神经麻痹，随后出现了右眼进行性视力丧失、右下象限视和左外展神经麻痹。复查MRI显示右侧海绵窦出现新的增强病变，血管炎累及左侧颈内动脉海绵内段，FLAIR高信号累及视交叉和左视束，硬脑膜增厚伴增强增强，与厚性脑膜炎一致。根据QuantiFERON-TB Gold试验阳性，怀疑是结核病。脑脊液分析显示轻度淋巴细胞增多症，但通过染色、培养和PCR检测均为结核分枝杆菌阴性。胸部影像学正常；然而，18F-FDG PET-CT发现了一个高代谢的髂淋巴结。切除显示上皮样细胞肉芽肿伴干酪样坏死，PCR检测（Xpert MTB/RIF Ultra）检测到结核分枝杆菌，经培养证实为药物敏感。患者接受四药抗结核方案联合皮质类固醇治疗，导致临床改善。她在皮质类固醇减量期间出现神经系统恶化，在剂量增加后消退。海绵窦受累是肺结核的一种罕见表现，通常无肺部疾病，影像学或脑脊液无特异性表现。高度的临床怀疑是必要的，确定一个可接近的颅外活检部位可能使明确的诊断，同时避免侵入性神经外科手术。

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引用次数: 0

IDCases最新文献

Background

Case presentation

Conclusions

Background

Case Presentation

Conclusion