Yamauchi Takahiro, Misaki Hirofumi, Arai Hajime, Iwasaki Hiromichi, Naiki Hironobu, Ueda Takanori
First Department of Internal Medicine, Fukui Medical University, 23-3 Shimoaizuki, Matsuoka, Fukui 910-1193, Japan.
J Infect Chemother. 2002 Mar;8(1):103-5. doi: 10.1007/s101560200015.
Mucormycosis is a rare, opportunistic infection caused by fungi of the order Mucorales, class Zygomycetes. These fungi produce fatal opportunistic infections in immunocompromised patients, especially in those with severe neutropenia. Recently, mucormycosis has become more widespread, because potent, myelosuppressive chemotherapies are performed more often than before. Nevertheless, this infection rarely occurs in patients with solid malignancies. Here, we describe an autopsy case of disseminated mucormycosis in a neutropenic patient who was receiving chemotherapy for an underlying solid malignancy. A 31-year-old Japanese man received cytotoxic chemotherapy with etoposide for the pulmonary metastasis of a secondary malignant fibrous histiocytoma. This patient had long been treated with chemotherapeutic agents for this solid cancer and for the preceding eosinophilic granuloma, both of which were highly resistant to the therapy. During the treatment with etoposide, his neutrophil count declined to less than 100/microl. He presented with high fever and severe dyspnea. Pneumonia was highly suspected. The chemotherapy was discontinued, and granulocyte colony-stimulating factor was administered. Although the neutrophil count recovered, the pneumonia progressed. The patient experienced respiratory failure and died 17 days after the onset of this episode. An autopsy revealed dissemination of mucormycosis not only in the lungs but also in the liver, the spleen, the kidney, and in the digestive tract. The therapy-related severe neutropenia, and the probable impairment of the immune system, because of the previous chemotherapies, would have been responsible for this fatal infection.
毛霉病是一种由接合菌纲毛霉目真菌引起的罕见的机会性感染。这些真菌在免疫功能低下的患者中引发致命的机会性感染，尤其是在严重中性粒细胞减少的患者中。最近，毛霉病变得更加普遍，因为强效的骨髓抑制性化疗比以前更频繁地进行。然而，这种感染在实体恶性肿瘤患者中很少发生。在此，我们描述一例接受化疗治疗潜在实体恶性肿瘤的中性粒细胞减少患者发生播散性毛霉病的尸检病例。一名31岁的日本男性因继发性恶性纤维组织细胞瘤肺转移接受依托泊苷细胞毒性化疗。该患者长期接受化疗药物治疗这种实体癌以及先前的嗜酸性肉芽肿，两者对治疗均高度耐药。在使用依托泊苷治疗期间，他的中性粒细胞计数降至每微升低于100个。他出现高热和严重呼吸困难。高度怀疑患有肺炎。化疗停止，并给予粒细胞集落刺激因子。尽管中性粒细胞计数恢复，但肺炎仍进展。患者出现呼吸衰竭，在此次发作后17天死亡。尸检显示毛霉病不仅在肺部播散，还在肝脏、脾脏、肾脏和消化道播散。与治疗相关的严重中性粒细胞减少以及由于先前化疗可能导致的免疫系统损害可能是这种致命感染的原因。
