免疫健常者にみられた浸潤型脳アスペルギルス症の1例

Invasive Cerebral Aspergillosis in an Immunocompetent Patient :： A Case Report

要旨　症例は32歳の免疫健常な女性で，左眼窩内アスペルギルス症の治療中，左側頭葉に病変が広がり，感覚性失語症，精神運動発作が出現した。Itraconazole内服投与開始後も病変は更に左側頭頭頂葉白質に広がり，症状が悪化した。浸潤病変部の定位的生検にて脳アスペルギルス症の確定診断を得た後，fluconazoleとamphotericin Bの点滴併用治療を開始し，病変部の明らかな縮小をみた。治療効果の評価にはMRIの他Ga-67シンチが有用であった。本例は明らかな免疫抑制状態にない点と浸潤性に脳実質内に病変が広がった点が特徴的であり，病態，診断，治療について文献的考察を加えるとともに脳内浸潤経路についても考察した。

　A 32-year-old immunocompetent female presented with sensory aphasia and psychomotor seizure due to aspergillosis in the left temporal lobe spreaded from the left orbita. In spite of oral administration of itraconazole, the symptoms continued to deteriorate due to extension of the lesion to the left temporoparietal white matter. As a result of the stereotactic biopsy of the lesion, she was histologically diagnosed as intracerebral aspergillosis. Intravenous administration of fluconazole and amphotericin B was apparently effective for the lesion, and the symptoms subsided. Ga-67 scintigram could serve as useful adjuncts to magnetic resonance images for evaluation of the therapy. This case is unusual in that an immunocompetent patient suffered from the intracerebral aspergillosis, which invasively spreaded into the parenchyma. We discussed about her pathology, diagnosis, therapy and the route of invasive aspergillosis to the parenchyma.