Background

Few central nervous systems (CNS) cases of actinomycetoma have been recorded in the literature, and most were reported in tropical and subtropical regions. The management of this invasive infection is difficult, especially when it affects the spine and the cranio-cervical regions.

Case

We report an unusual case of a cranio-cervical junction actinomycetoma, in a patient presenting a cerebellar syndrome from brainstem compression. The CT scan showed a compressive solid osteolytic lesion in the cranio-cervical junction. The patient underwent cranio-cervical decompression and lesion resection. The diagnosis of actinomycetoma was confirmed on immune-histochemistry and molecular analysis. At 4 months’ follow-up, the patient presented a fatal recurrence disseminating within the cerebellum and the spine.

Conclusion

The surgical treatment of CNS actinomycetoma presented poor prognosis and a disseminating recurrence. We believe that clinicians and surgeons must be informed about these “new” infectious pathologies that are so difficult to treat, especially with the arrival of migrant patients from endemic countries in conflict.

中文翻译：

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脊髓和颅颈足菌肿：手术难度大，预后差

背景

文献中很少记录放线菌肿的中枢神经系统 (CNS) 病例，大多数报告发生在热带和亚热带地区。这种侵袭性感染的治疗很困难，特别是当它影响脊柱和颅颈区域时。

案子

我们报告了一例颅颈交界处放线菌瘤的不寻常病例，患者因脑干受压而出现小脑综合征。CT 扫描显示颅颈交界处有压缩性实性溶骨性病变。患者接受了颅颈减压和病灶切除术。放线菌肿的诊断经免疫组织化学和分子分析证实。在 4 个月的随访中，患者出现致命的复发，在小脑和脊柱内播散。

结论

中枢神经系统放线菌瘤的手术治疗预后较差，且有播散性复发。我们认为，临床医生和外科医生必须了解这些难以治疗的“新”传染性疾病，尤其是随着来自冲突地区流行国家的移民患者的到来。