既往健康年轻成人继发于额窦炎的暴发性坏死梭杆菌脑膜脑炎：一例病例报告

文献信息

中文摘要

背景： 坏死梭杆菌是一种厌氧革兰阴性菌，典型与严重头颈部感染和Lemierre综合征相关。中枢神经系统受累不常见，但可能快速进展并致命，尤其当与鼻窦炎、颅内积脓、脑炎或脑脓肿相关时。
病例介绍： 我们报告一例既往健康的18岁男性，在出现高达41.5°C的高热、严重全头痛、呕吐和急性过度活跃性谵妄四天后就诊。入院时，他有脑膜刺激征、炎症标志物显著升高，并同时感染甲型流感。初始头颅计算机断层扫描显示左额叶低密度病灶伴出血转化和灌注缺损。头颅磁共振断层扫描显示左额极脑炎、沿大脑镰和小脑幕的颅内积脓、椎管内延伸，以及广泛的双侧额窦、上颌窦和筛窦炎，提示鼻源性颅内播散。患者接受了紧急双侧全组鼻窦手术、放置脑室外引流、左侧半颅骨切除术并清除积脓、再次清除硬膜下积脓和额叶脓肿引流，以及后颅窝减压伴C1椎板切除术。在厌氧血培养和术中颅内样本中检测到坏死梭杆菌。尽管进行了积极的多学科管理，患者仍发生脓毒性多器官衰竭，并于住院第4天死亡。
结论： 本病例说明了一例年轻成人中罕见但可能致命的鼻源性坏死梭杆菌中枢神经系统感染。通过提供详细报告，我们旨在提高对这种罕见但致命临床表现的认识。

英文摘要

BACKGROUND: Fusobacterium necrophorum is an anaerobic Gram-negative organism classically associated with severe head and neck infections and Lemierre syndrome. Central nervous system involvement is uncommon but may be rapidly progressive and fatal, particularly when associated with sinusitis, intracranial empyema, cerebritis, or brain abscess.
CASE PRESENTATION: We report the case of a previously healthy 18-year-old male who presented after four days of high fever up to 41.5 °C, severe holocranial headache, vomiting, and acute hyperactive delirium. On admission, he had meningismus, markedly elevated inflammatory markers, and concomitant Influenza A infection. The initial cranial computer tomography showed a left frontal hypodense lesion with hemorrhagic transformation and perfusion deficit. The cranial magnetic resonance tomography demonstrated left frontopolar cerebritis, intracranial empyema along the falx and tentorium, intraspinal extension, and extensive bilateral frontal, maxillary, and ethmoidal sinusitis, suggesting sinogenic intracranial spread. The patient underwent emergency bilateral pansinus surgery, placement of an external ventricular drain, left hemicraniectomy with evacuation of empyema, repeat evacuation of subdural empyema and frontal abscess drainage, and posterior fossa decompression with C1 laminectomy. Fusobacterium necrophorum was detected in anaerobic blood cultures and the operative intracranial samples. Despite aggressive interdisciplinary management, the patient developed septic multiorgan failure and died on hospital day 4.
CONCLUSIONS: This case illustrates a rare but potentially fatal sinogenic Fusobacterium necrophorum infection of the central nervous system in a young adult. By providing a detailed report, we intend to increase awareness of this rare yet fatal clinical presentation.