著明なGranulomatous Pachymeningitisを呈したアスペルギルス症の1例

A Case of Aspergillosis Presenting Marked Granulomatous Pachymeningitis

I．はじめに

　中枢神経系のアスペルギルス症は従来稀な疾患と考えられてきたが，近年抗生物質，抗癌剤，副腎皮質ステロイド等の使用頻度が増加するにともない，その報告が増加し臨床的意義が大きくなりつつある．しかしながら本症の臨床像は多彩であるためその診断は容易ではない．今回われわれは，著明なgranulomatous pachymenin—gitisの臨床像を呈したアスペルギルス症の1例を経験する機会を得たので若干の文献的考察を加え報告する．

The authors report a rare case of intracranial asper-gillosis presenting marked granulomatous pachymenin-gitis.

A 58-year-old male who had a three-year history of diabetes and chronic bronchitis was referred to us be-cause of progressive left hemiparesis and dysarthria. Postcontrast CT scan showed a ring-enhancing lesion with marked perifocal edema in the right parietal lobe, and right subdural enhancing mass. MR image revealed hypertrophic dura mater in the right convexity.

On June 9, 1992, partial removal of the intra-axial cystic mass and granulomatous dura mater was per-formed. A number of characteristic aspergillus hyphae were recognized in the resected cyst and granulomatous dura mater. Postoperatively, the patient was treated with amphotericin-B and fluconazole. But granuloma-tous pachymeningitis became progressively enlarged and eventually created a large mass effect again. On January 23, 1993, the patient died of pneumonia.

Cerebral aspergillosis is getting common but preop-erative diagnosis is still difficult because of its causing several clinical features such as brain abscess, granulo-ma, intracerebral hemorrhage, cerebral infarction, meningitis, and encephalitis.

Several comments were made about the pathogenesis of these features, and the necessity of early diagnosis and treatment was emphasized.