TY - JOUR A2 - Olumese，彼得AU - 赖利，艾琳AU - 黄某，贾斯汀PY - 2020 DA - 2020年4月25日TI - 李斯特菌脑炎与肿瘤坏死因子抑制SP - 4901562 VL - 2020 AB - 背景。 李斯特菌是历史上考虑的很年轻，很老了，免疫抑制中枢神经系统病原体。诊断 李斯特菌是基于正体液培养或PCR测试。脑水肿是特异性的，且可以是血管炎，外伤，缺氧，局部缺血，心肌梗死，恶性肿瘤，或感染过程的一种表现。对免疫保护的主要机制 李斯特菌是肿瘤坏死因子（TNF）。来那度胺，免疫抑制剂，抑制TNF。 病例报告。A 61-year-old female with diabetes mellitus 2 and multiple myeloma treated with stem cell transplant and immunosuppressant (lenalidomide) was found to have cerebral edema after presenting with headache for 3 weeks and new focal neurologic deficits. Vitals signs were stable, with no meningeal exam findings and unremarkable initial serum testing. Blood cultures on days 0 and 2 of hospitalization as well as cerebral spinal fluid cultures were negative for infectious organisms. PCR testing of CSF was also negative for microorganisms. Brain biopsy was scheduled but postponed due to outstanding prion testing. The patient’s focal neurologic deficits worsened prompting administration of dexamethasone after extensive negative infectious disease workup. By day 6, gross neurologic function deteriorated prompting transfer to higher level of care where the patient spiked a fever and one set of blood cultures revealed Gram-positive bacillus. Aggressive antimicrobial therapy was initiated, excluding ampicillin; however, this was later added. Blood culture further identified 李斯特菌。17天，患者遭受灭亡。验尸报告显示脑部病灶微脓疡一致 李斯特菌。 结论。临床医师应使用预防性抗菌治疗 李斯特菌当照顾这些病人的脑水肿呈递谁是免疫用TNF抑制抑制不管初始检查发现，血清测试，和/或放射学解释。如果初始检查是阴性，需要脑组织活检，以确定与脑水肿病人接下来的行动过程中，患者在您的工厂能够以有利的方式传送到护理更高水平，如果无法完成活检。SN - 2090-6625 UR - https://doi.org/10.1155/2020/4901562 DO - 10.1155 /四百九十○万一千五百六十二分之二千〇二十〇JF - 病例报告传染病PB - Hindawi出版KW - ER -