检验医学与临床2024，Vol.21Issue(9)：1317-1320,4.DOI:10.3969/j.issn.1672-9455.2024.09.028
自身免疫性脑炎并发培养阴性抗原阳性肺隐球菌病的临床研究
Clinical study of autoimmune encephalitis complicated by culture-negative antigen-positive pulmonary cryptococcosis
摘要
Abstract
Objective To analyze the diagnosis and treatment of a case of autoimmune encephalitis compli-cated by pulmonary cryptococcal infection with negative cryptococcal culture,detection of cryptococcus neofor-mans sequences by metagenomics next-generation sequencing(mNGS),and positive detection of cryptococcal antigens.Methods The clinical data of a patient with positive serum cryptococcal capsular polysaccharide an-tigen and autoimmune encephalitis were analyzed.Routine tests,biochemical tests,microbial culture and bron-choscopic alveolar lavage fluid(BALF)by mNGS were adopted to clarify the type of pneumonia infection.Pulmonary cryptococcosis was reviewed and discussed combining with relevant literatures.Results The pa-tient was negative in HIV testing and sputum Xpert MTB/RIF assay for Mycobacterium tuberculosis.Sputum and BALF bacterial culture results were normal flora growth and cryptococcal culture was negative.Blood cul-ture result was negative.The routine tests,biochemical tests,and microbiologic cultures of cerebrospinal fluid showed normal results.Cryptococcal antigen of cerebrospinal fluid was negative and no cryptococcus was de-tected by ink staining.BALF by mNGS suggested cryptococcus neoformans with reads 6,relative abundance of 46.15%and coverage of 0.001 0%.After 3 months of oral fluconazole treatment,the patient's lung CT showed a classically round nodular shadow with a cavity in the lower lobe of the right lung that was smaller than before.Conclusion The combination of serum cryptococcal polysaccharide antigen and mNGS analysis of respiratory specimens in immunocompromised patients with cavities detected on lung imaging can be effective for clinical diagnosis and treatment of pulmonary cryptococcosis.关键词
肺隐球菌病/自身免疫性脑炎/宏基因组二代测序/隐球菌荚膜多糖抗原Key words
pulmonary cryptococcosis/autoimmune encephalitis/metagenomics next-generation se-quencing/cryptococcal capsular polysaccharide antigen分类
医药卫生引用本文复制引用
姚怡婷,潘允琪,曾健,徐伟红..自身免疫性脑炎并发培养阴性抗原阳性肺隐球菌病的临床研究[J].检验医学与临床,2024,21(9):1317-1320,4.基金项目
上海市长宁区新发感染与免疫调控博士创新人才基地(RCJD2021B01) （RCJD2021B01）
肠道微生物与疾病交叉科创基地 （）
上海交通大学同仁医院课题项目(TR2018T01). （TR2018T01）
