Mycology Laboratory, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil.
Mycopathologia. 2012 Mar;173(2-3):187-92. doi: 10.1007/s11046-011-9472-0. Epub 2011 Sep 28.
We identified the etiological agents responsible for two fatal cases of rhinocerebral mucormycosis with the classical risk factor for uncontrolled type II diabetes mellitus. Their initial symptoms did not point immediately to the suspicion of mucormycosis. Case 1, caused by Rhizopus microsporus var. oligosporus, was a 52-year-old man who presented with a painful pimple on his nose, which evolved with swelling, erythema, and a central pustule on his right hemiface suspected to be cellulitis. After 7 days of antibiotic treatment, the patient worsened with signs of sepsis and the lesion evolved to necrosis involving all his right face. Case 2, caused by Rhizopus microsporus var. rhizopodiformis, was a 57-year-old woman placed on continuous therapy with azathioprine and corticoids after a renal transplant due to chronic arterial hypertension and uncontrolled type II diabetes mellitus. Because she was suspected to have sepsis, the patient was treated with broad-spectrum antibiotics and mechanical ventilation, yet she deteriorated. Because Candida spp. were isolated from urine and a BAL, she was treated with fluconazole for 10 days, then substituted by caspofungin. Two weeks later, she presented with exophthalmus of the left eye that was surrounded by a large inflammatory and necrotic area. Both patients were the diagnosed with mucormycosis via direct microscopy of necrotic material prior to their death.
我们鉴定出两例致命性鼻脑毛霉病的病原体，这两例均有未控制的 II 型糖尿病这一经典的高危因素。他们的初始症状并未立即指向毛霉病的怀疑。由少根根霉变种寡孢变种引起的病例 1 为一名 52 岁男性，最初表现为鼻部疼痛性丘疹，随后右半侧面部出现肿胀、红斑和中央脓疱，疑似蜂窝织炎。在接受 7 天抗生素治疗后，患者病情恶化，出现脓毒症迹象，病变进展为累及整个右侧面部的坏死。由少根根霉变种根状变种引起的病例 2 为一名 57 岁女性，因慢性动脉高血压和未控制的 II 型糖尿病进行了肾移植后，一直接受硫唑嘌呤和皮质类固醇的连续治疗。由于怀疑败血症，患者接受了广谱抗生素和机械通气治疗，但病情恶化。由于从尿液和 BAL 中分离出了念珠菌属，她接受了氟康唑治疗 10 天，然后改为卡泊芬净。两周后，她出现左眼突出，周围有一个大的炎症和坏死区域。两名患者在死亡前均通过对坏死组织进行直接显微镜检查诊断为毛霉病。
