摘要

腎臟移植是末期腎病患者最佳治療方式，並與血液透析相比更能提高病人生活品質和患者生存率具有成本效益。長期使用免疫抑制藥物雖可防止排斥反應，但也會抑制免疫系統、增加感染風險。隱球菌腦膜炎 (Cryptococcal meningitis) 是腎移植後常見嚴重的感染源之一，具有20% 至50% 的高死亡率。本研究探討兩例腎移植後罹患隱球菌腦膜炎的病例，分析其臨床特徵、診斷過程與治療經驗。

案例中，53 歲和48 歲男性患者分別於腎移植後四年和八個月主要因頭痛等症狀入院。兩位患者均有禽鳥接觸史，最後被診斷為隱球菌腦膜炎。兩例患者均接受了Amphotericin B 並用Flucytosine 的誘導治療，後期轉使用Fluconazole 進行維持治療，並根據患者情況與藥物血中濃度調整免疫抑制劑的劑量。

隱球菌感染的發病風險與免疫抑制劑的使用密切相關，尤其是鈣調神經磷酸酶抑制劑 (calcineurin inhibitor) 與類固醇的併用。早期診斷及適時調整免疫抑制劑是減少感染造成死亡風險的重要關鍵。本案例報告闡述對腎移植患者在懷疑隱球菌腦膜炎時，進行經驗性治療、持續監測以及作為免疫抑制劑劑量調整的重要參考。

 

ABSTRACT

Kidney transplantation is the optimal treatment for patients with end-stage renal disease, offering better quality of life and survival rates compared with hemodialysis and demonstrating cost-effectiveness. Although long-term use of immunosuppressive medications prevents rejection, it also suppresses the immune system, increasing the risk of infections. Cryptococcal meningitis is one of the common and severe infections post-kidney transplantation, with a high mortality rate ranging from 20% to 50%. This case report investigated two cases kidney transplant recipients who developed cryptococcal meningitis, focusing on their clinical characteristics, diagnostic processes, and treatment experiences.

The cases included two male patients, aged 53 and 48 years, who were hospitalized due to headaches four years and eight months after transplantation, respectively. Both patients had a history of exposure to birds and were ultimately diagnosed with cryptococcal meningitis. They received induction therapy with Amphotericin B and Flucytosine, followed by maintenance therapy with Fluconazole. The dosage of immunosuppressive agents was adjusted based on the patients' conditions and drug serum concentrations.

The risk of cryptococcal infection is closely associated with the use of immunosuppressive agents, particularly the combination of calcineurin inhibitors and steroids. Early diagnosis and timely adjustment of immunosuppressive therapy are crucial for reducing infection-related mortality. This case report underscored the importance of empirical treatment, monitoring, and appropriate dose adjustments of immunosuppressive agents for kidney transplant recipients to prevent cryptococcal meningitis.

 

 

Submitted for publication: 2024.12.19; Accepted for publication: 2025.05.19.