Minet C, Bonadona A, Tabah A, Karkas A, Mescam L, Schwebel C, Hamidfar R, Pison C, Saint-Raymond C, Faure O, Salameire D, Timsit J-F
Unité de Pneumologie, Pôle de médecine aiguë communautaire, CHU de Grenoble, France.
Rev Mal Respir. 2009 Nov;26(9):998-1002. doi: 10.1016/s0761-8425(09)73337-6.
Mucormycosis is a rare fungal infection occurring most frequently in immunocompromised patients. The pathogens are filamentous fungi, order of Mucorales. Disseminated mucormycosis is a severe, life treating disease. Early diagnosis is a major determinant for prognosis, however, it remains difficult. The management consists in an early antifungal therapy using lipid formulation of amphotericin B associated with an extensive surgical debridement. Despite this therapeutic of choice, the mortality of disseminated mucormycosis remains high.
We report the case of disseminated mucormycosis in a 25 years old woman 9 months after a pulmonary transplantation. The clinical presentation included pulmonary and thyroid localization and the pathogen was Absidia corymbifera. The patient survived thanks to a large surgical debridement, and an early antifungal bitherapy by lipid formulation of amphotericin B and posaconazole.
The re-emergence and the high mortality of mucormycosis in solid organ transplant receiver show the necessity to find new therapeutic approaches. Posaconazole associated with liposomal amphotericin B could be an interesting option to treat disseminated mucormycosis and improve their outcome.
毛霉病是一种罕见的真菌感染，最常发生于免疫功能低下的患者。病原体为丝状真菌，属于毛霉目。播散性毛霉病是一种严重的、危及生命的疾病。早期诊断是预后的主要决定因素，然而，早期诊断仍然困难。治疗方法包括早期使用两性霉素B脂质体进行抗真菌治疗，并联合广泛的手术清创。尽管采用了这种首选治疗方法，但播散性毛霉病的死亡率仍然很高。
我们报告了一例25岁女性在肺移植9个月后发生播散性毛霉病的病例。临床表现包括肺部和甲状腺受累，病原体为伞枝犁头霉。患者通过广泛的手术清创以及早期使用两性霉素B脂质体和泊沙康唑进行抗真菌联合治疗而存活。
实体器官移植受者中毛霉病的再次出现和高死亡率表明有必要寻找新的治疗方法。泊沙康唑联合脂质体两性霉素B可能是治疗播散性毛霉病并改善其预后的一个有意义的选择。
