임산부에서 발생한 폐크립토콕쿠스증을 동반한 크립토콕쿠스 수막뇌염 1예
A Case of Cryptococcal Meningoencephalitis with Cryptococcal Pneumonia in Pregnancy
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Cryptoccus neoformans는 면역기능이 저하된 환자에서 기회 감염을 일으키는 진균이나 정상인에서도 드물게 질병을 일으킨다. 그러나 임산부에서 폐크립토콕쿠스증을 동반한 크립토콕쿠스 수막염의 보고는 아주 드물다. 저자들은 분만 후에도 악화되는 두통과 의식저하로 내원한 임신 37주의 임산부에서 뇌척수액과 폐조직검사를 통해 폐크립토콕쿠스증을 동반한 크립토콕쿠스 수막뇌염을 진단하고 항진균제를 사용하여 치료하였다. 본 증례처럼 명백한 기저질환이 없는 임산부에서도 크립토콕쿠스 수막염은 발생할 수 있으므로 의심이 되면 뇌척수액검사를 포함한 진단적 검사를 시행하고 적절한 치료를 시작해야 한다. 그리고 임산부에서 크립토콕쿠스증이 발생한 경우의 치료에 대하여 문헌 고찰과 함께 보고하는 바이다.
Abstract
Cryptoccocosis occurs more frequently in immunocompromised hosts such as patients with AIDS, lymphoma, leukemia and other debilitating diseases. Pulmonary cryptococcosis can occur in the absence of any recognized immunodeficiency and cryptococcal meningitis can occur rarely during pregnancy. Although it is extremely rare, we encounter the reports of case of cryptococcal pneumonia and combined cryptococcal meningitis during pregnancy. We present here that 36-year-old pregnant woman, who was previously healthy, with cryptococcal meningoencephalitis and cryptococcal pneumonia was treated with amphotericin B and flucytosine. The maternal outcome was favorable, and there is no evidence of congenital infection in the newborn.
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