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例1,男性,30岁,农民,主因头痛、发热1个月于1995年8月24日入院,既往有系统性红斑狼疮史。3个月前复发,口服强的松30mg/日。1个月前出现后枕部头痛,发热,体温在37.5℃～38.9℃,伴恶心,呕吐。半月前行腰穿检查,脑脊髓(CSf)压力3.92kPa,涂片查到新型隐球菌,给予氟康唑首次剂量400mg/日,之后200mg/日,14天后仍间断头痛,转住我院。查体:Bp25/16kPa,贫血貌,“满月脸”,面部可见对称性蝶形红斑,腹水征(十),双下肢水肿。神经科查体:神清,语畅,双眼视乳头水肿,颈抵抗(+)。继续静点氟康唑每日200mg。1周后主诉视物不清,查双眼视盘边界不清,其周围网膜水肿,有小片状出血,治疗13天疗效不显著,自动出院,一周后死亡。
Example 1, male, 30 years old, farmer, mainly due to headache, fever 1 month on August 24, 1995 admitted to the hospital with a history of systemic lupus erythematosus. 3 months ago, oral prednisone 30mg / day. After a month ago occipital headache, fever, body temperature 37.5 ℃ ~ 38.9 ℃, with nausea and vomiting. Half a month before the lumbar puncture examination, cerebral spinal cord (CSf) pressure 3.92kPa smear found Cryptococcus neoformans, giving fluconazole first dose of 400mg / day, 200mg / day, 14 days after the headache is still interrupted, transferred to our hospital. Physical examination: Bp25 / 16kPa, anemic appearance, “full moon face”, facial symmetry visible butterfly erythema, signs of ascites (ten), lower extremity edema. Neurology examination: Shen Qing, language Chang, binocular papilledema, neck resistance (+). Continue to intravenous fluconazole 200mg daily. One week later, the main complaint was unclear. The boundary of the binocular optic disc was unclear. The peripheral retinal edema and small flaky hemorrhage were observed. The curative effect was insignificant for 13 days and was discharged automatically and died a week later.