脳真菌症の病理学的検索

A PATHOLOGICAL STUDY ON CEREBRAL MYCOSIS

　抄録　1976〜1981年の6年間における当教室での剖検528例のうち，開頭ができた例は46％であるが，その中で7例に脳真菌症を確認した。いずれも基礎疾患に続発したもので，5例が血液疾患，他の2例はSLEと，長期間静脈内にカテーテルを留置した心筋梗塞例であつた。真菌症の内訳は，アスペルギルスとカンジダとの重複感染が1例あり，その他はアスペルギルス症が2例，ムーコル症2例，カンジダ症1例，それにクリプトコックス症1例で，クリプトコックス症の1例以外は生前診断されておらず，また6例が播種性真菌症例であった。アスペルギルス症およびムーコル症はいずれも出血性，壊死性病変を呈し，カンジダ症では微小な膿瘍ないし肉芽腫性病変が散在性に認められ，クリプトコックス症では髄膜に膠様性炎の像がみられた。また，脳型ムーコル症の1例以外では，末梢血リンパ球数は500／mm³以下に減少していた。今後，末梢血リンパ球数の著明な減少があり，重篤な基礎疾患があるか，もしくは静脈内カテーテルを留置している患者で，脳神経症状が認められる場合には，つねに脳真菌症の可能性を念頭におく必要があると思われる。

The histopathological examination was perfor-med in search of cerebral mycosis in autopsy cases at our department during the 6 years from 1976 to 1981. The cerebral mycoses were histo-pathologically verified in seven cases, although brain tissue was examined in only 46% of 528 autopsy cases. All cases of cerebral mycosis showed underlying diseases which were hematologic diseases (5 cases), SLE (1 case), and myocardial infarction with indwelling deep venous lines (1 case). Among these cerebral mycosis, one had double fungal infections with aspergillus and candida, while others were as follows; aspergil-losis (2 cases), mucormycosis (2 cases), candidiasis (1 case) and cryptococcosis (1 case). Six cases were not diagnosed antemortem with exception of a case of cryptococcosis. Systemic fungal infec-tions were seen in six cases, however, a case of mucormycosis was without systemic infection. Each cerebral mycosis showed its own character-istic histopathologic findings, namely, hemorrhagic and necrotic lesions in aspergillosis and mucormy-cosis, scattered minute abscesses or granulomatous lesions in candidiasis, and gelatinous lesions in leptomeninges in cryptococcosis. Severe lymphocy-topenia (less than 500/mm³) was always present in all except a case of rhinocerebral mucormycosis.

It is emphasized that cerebral mycosis should be always considered when neurological symptoms were clinically observed in patients who had severe underlying diseases and/or deep venous lines with severe lymphocytopenia.