儿童激素耐药型肾病综合征合并星形诺卡菌脑脓肿1例

本文报道1例激素耐药型肾病综合征儿童合并星形诺卡菌(Nocardia asteroides，N.asteroides)脑脓肿。患儿，男性，8岁，临床诊断为原发性肾病综合征(激素耐药型)，病理诊断为局灶节段性肾小球硬化症(经典型)。肾穿后第4天患儿出现持续高热、抽搐，时有头痛，抗感染、抗凝治疗效果不佳。复查颅脑磁共振成像(magnetic resonance imaging，MRI)提示多发脑脓肿。头颅脓肿液经穿刺后培养显示为星形诺卡菌感染。予以多种抗生素联合糖皮质激素等治疗2个月，患儿体温正常，头痛缓解，脑脓肿范围明显缩小。因此，肾病综合征患儿在应用激素及免疫抑制剂治疗过程中如出现化脓性炎症，常规抗生素疗效差，应积极寻找病原，高度警惕诺卡菌病及其他机会性感染的可能。

A case of brain abscesses infected by nocardia asteroids in a child with steroid-resistant nephrotic syndrome

A case of brain abscesses infected by Nocardia asteroids in a child with steroid-resistant nephrotic syndrome was reported. An 8-year-old male patient was clinically diagnosed as primary nephrotic syndrome (steroid-resistant). Renal biopsy pathology showed focal segmental glomerulosclerosis (typical). On the fourth day after Reno puncture, he suffered from persistent high fever, convulsions, and headache. He received anti-infection and anticoagulant treatment, but his health did not improve. Repeat cerebral MRI showed multiple brain abscesses, puncture liquid culture of the brain abscesses confirmed Nocardia asteroids infection. After multiple antibiotics combined glucocorticoid therapy for 2 months, patient conditions improved, including body temperature returned to normal, headache relief, and brain abscess narrowing down. The case indicated that once refractory pyogenic diseases occurred after routine antibiotics therapy in children with nephrotic syndrome receiving corticosteroids and immunosuppressive treatment, nocardiosis and other opportunistic pathogen infections and attentions on the dosage of corticosteroid and immunosuppressants should be considerate at the same time.