CASE REPORTS   

Journal of Neurosurgical Sciences 2003 June;47(2):101-5

Copyright © 2004 EDIZIONI MINERVA MEDICA

lingua: Inglese

Isolated intracranial infection with Myco-bacterium aviun complex

Dicherman D. R. ¹, Stevens Q. E. J. ², Rak R. ³, Dorman S. E. ⁴, Holland S. M. ⁴, Nguyen T. T. ³

¹ Department of Neurosurgery, Long Island Jewish Hospital, New Hyde Park, NY, USA 2 Department of Neurosurgery, St. James Hospital, Olympia Fields, IL, USA 3 Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA 4 Laboratory of Host Defenses, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA

Mycobacterium avi­um-M. com­plex (MAC) has ­been ­linked to dev­as­tat­ing res­pir­a­to­ry and system­ic ill­ness­es in ­patients, espe­cial­ly in ­those who are immu­no­sup­pressed. The pur­pose of ­this ­study is to ­describe a ­case of iso­lat­ed cen­tral ner­vous ­system (CNS) infec­tion ­with MAC. This is a sin­gle ­case ­report of a ­patient ­with iso­lat­ed intra­cra­ni­al myco­bac­te­ri­al infec­tion. Setting: the ­patient was treat­ed and the immu­no­his­to­chem­i­cal inves­ti­ga­tions ­were under­tak­en at the National Institutes of Health in Bethesda, Maryland, USA. Intervention: the ­patient initial­ly was treat­ed ­with a cock­tail of anti­my­co­bac­te­ri­al med­i­ca­tions. However, ­because his dis­ease was refrac­to­ry, he under­went a sub­oc­cip­i­tal cran­i­ot­o­my and evac­u­a­tion of his cer­e­bel­lar ­mass. The ­patient was deter­mined to ­have a low pro­duc­tion of inter­fer­on-γ (INF-γ) and ­tumor necro­sis fac­tor-α (TNF-α) ­when com­pared to nor­mal val­ues. Despite exten­sive radio­graph­ic imag­ing stud­ies and biop­sies, ­there was no evi­dence of ­another ­focus of MAC infec­tion in ­this ­patient. We con­clude ­that intra­cra­ni­al infec­tious ­lesions in ­patients ­such as ­ours ­should be treat­ed ­with con­ven­tion­al system­ic anti­bi­o­tic reg­i­mens as the fir­st-line of ther­a­py. We sug­gest neu­ro­sur­gi­cal inter­ven­tion in med­i­cal­ly refrac­to­ry cas­es of intra­cra­ni­al infec­tions.