角回症候群を呈したアスペルギルス脳膿瘍の1症例

A Case of Aspergillus Brain Abscess Presenting Angular Gyrus Syndrome

　要旨　患者は45歳男性。2000年9月に急性アルコール中毒の治療中に発熱を認め，胸部X線写真と陽性炎症反応およびβ-Dグルカン高値から肺真菌症と診断した。Fluconazole（FLCZ）投与にて肺真菌症の改善を認めたが，2001年2月に強直性間代性けいれんが発現し，頭部CTにて左頭頂葉に脳膿瘍を認めた。臨床経過より肺真菌症から続発した真菌性脳膿瘍と診断した。FLCZの投与を継続していたが，角回症候群が出現した。造影MRI画像にて膿瘍の被膜肥厚を認めることから外科的適応と考え，同年8月に膿瘍摘出術を施行した。摘出組織中にアスペルギルス菌糸と炎症細胞の浸潤を認めたことからアスペルギルス脳膿瘍と診断した。手術後に角回症候群は改善した。

　A 45-year-old man had been treated for chronic alcoholism and he had fever in September 2000. He was diagnosed as lung aspergillosis from chest X-ray findings, leukocytosis, elevated CRP, and β-D-glucan. Administration of fluconazole was started and his lung lesion subsided. But, generalized clonic tonic convulsion developed and the brain abscess in the left parietal lobe was found by CT. Therefore we made the diagnosis of brain abscess followed by lung aspergillosis. He also showed angular gyrus syndrome. Its capsule was thick and localized in the left parietal lobe. The patient had the surgical resection in August, 2001. Aspergillus hyphae and infiltration of inflammatory cells were seen in the brain sample, therefore the diagnosis of aspergillosis brain abscess was established. Angular gyrus syndrome was ameliorated after the operation.

（Received : February 9, 2004）