Leithauser M, Kahl C, Aepinus C, Prall F, Maruschke M, Riemer H, Wolff D, Jost K, Hilgendorf I, Freund M, Junghanss C
Department of Medicine, Division of Hematology/Oncology, University of Rostock, Rostock, Germany.
Transpl Infect Dis. 2010 Jun;12(3):251-7. doi: 10.1111/j.1399-3062.2009.00480.x. Epub 2009 Dec 7.
Invasive mold infections are a threat to immunosuppressed patients such as patients with graft-versus-host disease (GVHD) after allogeneic stem cell transplantation (SCT). Up to 10% of SCT recipients develop invasive aspergillosis (IA). Invasive zygomycosis (IZ) may occur during treatment against IA. Here we report 4 SCT patients with GVHD diagnosed with IZ. All patients had received myeloablative hematopoietic SCT and developed chronic GVHD requiring systemic immunosuppression. Underlying diseases were acute lymphocytic leukemia (2), osteomyelofibrosis, and multiple myeloma. All patients had developed pulmonary infiltration that led to initiation of antifungal therapy. Treatment for IA was voriconazole, caspofungin, or itraconazole. Organs involved with zygomycosis were lung, nasal sinus, skin, and kidney. Treatment with liposomal amphotericin and posaconazole was initiated in all patients, and 2 patients also had surgical debridement as well. Despite intensive treatment, no patient survived. IZ is becoming more common in patients with GVHD on successful treatment for IA. Even non-specific symptoms are suspicious in this group of patients and need to be evaluated by vigorous diagnostics. Despite effective antifungals and surgical intervention, the prognosis is grim in patients with active GVHD, as immunoreconstitution is mandatory for successful management.
侵袭性霉菌感染对免疫抑制患者构成威胁，例如异基因干细胞移植（SCT）后发生移植物抗宿主病（GVHD）的患者。高达10%的SCT受者会发生侵袭性曲霉病（IA）。在针对IA的治疗过程中可能会发生侵袭性接合菌病（IZ）。在此，我们报告4例诊断为IZ的GVHD的SCT患者。所有患者均接受了清髓性造血SCT，并发生了需要全身免疫抑制的慢性GVHD。基础疾病为急性淋巴细胞白血病（2例）、骨髓纤维化和多发性骨髓瘤。所有患者均出现肺部浸润，从而开始抗真菌治疗。IA的治疗药物为伏立康唑、卡泊芬净或伊曲康唑。接合菌病累及的器官有肺、鼻窦、皮肤和肾脏。所有患者均开始使用脂质体两性霉素和泊沙康唑治疗，2例患者还接受了手术清创。尽管进行了强化治疗，但无一例患者存活。在成功治疗IA的GVHD患者中，IZ正变得越来越常见。即使是非特异性症状在这类患者中也值得怀疑，需要通过积极的诊断进行评估。尽管有有效的抗真菌药物和手术干预，但对于活动性GVHD患者，预后仍然严峻，因为免疫重建是成功治疗的关键。
