RESUMO
Resumen Las feohifomicosis cerebrales son infecciones graves causadas por mohos dematiáceos, entre los cuales Cladophialophora bantiana es una de las especies más comúnmente aislada. Esta tiene tropismo por el sistema nervioso central y frecuentemente produce abscesos cerebrales en pacientes inmunocompetentes; además, en los inmunocomprometidos también puede ocasionar infección diseminada. Pese a la disponibilidad de medicamentos antifúngicos de amplio espectro, a menudo se requiere también la intervención quirúrgica; de todas maneras, la mortalidad es elevada. El diagnóstico debe hacerse interviniendo para tomar la muestra y hacer el cultivo y las pruebas de sensibilidad. Se presenta aquí el caso de un paciente con trasplante renal que presentó un absceso cerebral por C. bantiana, el cual se extrajo mediante resección quirúrgica. El paciente recibió tratamiento con voriconazol, con adecuada respuesta, mejoría y sin secuelas neurológicas.
Abstract Cerebral feohifomycosis are severe infections caused by dematiaceous fungi. Cladophialophora bantiana is one of the most commonly isolated species; it has central nervous system tropism and it often manifests as a brain abscess in immunocompetent patients. In immunocompromised patients, it can lead to brain abscesses and disseminated infections. Despite the availability of broad-spectrum antifungal drugs, it is a must to perform surgical management, in addition to drug therapy. However, mortality is high. The diagnostic approach must be invasive to establish a timely diagnosis and direct treatment based on culture and susceptibility tests. We report a case of brain abscess caused by C. bantiana in an immunosuppressed patient who was treated with surgical resection and voriconazole with an adequate response to therapy and without neurological sequels.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/microbiologia , Abscesso Encefálico/microbiologia , Transplante de Rim , Saccharomycetales/isolamento & purificação , Feoifomicose Cerebral/microbiologia , Complicações Pós-Operatórias/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/tratamento farmacológico , Recidiva , Hiperoxalúria Primária/complicações , Hiperoxalúria Primária/diagnóstico , Hiperoxalúria Primária/genética , Abscesso Encefálico/cirurgia , Abscesso Encefálico/etiologia , Abscesso Encefálico/tratamento farmacológico , Anfotericina B/uso terapêutico , Diálise Renal , Hospedeiro Imunocomprometido , Terapia Combinada , Craniotomia , Nefrolitíase/etiologia , Feoifomicose Cerebral/cirurgia , Feoifomicose Cerebral/etiologia , Feoifomicose Cerebral/tratamento farmacológico , Rejeição de Enxerto/tratamento farmacológico , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Antifúngicos/uso terapêuticoRESUMO
Primary hyperoxaluria type 1 [PH1] is an autosomal recessive disorder caused by a deficiency of alanine-glyoxylate aminotransferase AGT, which is encoded by the AGXT gene. We report an Indian family with two affected siblings having a novel mutation in the AGXT gene inherited from the parents. The index case progressed to end stage renal disease at 5 months of age. His 4 month old sibling is presently under follow up with preserved renal function.