Gupta Vipin, Rajagopalan Natarajan, Patil Mahantesh, Shivaprasad C
Department of Pulmonology and Critical Care, Mazumdar Shaw Medical Center, Narayana Health, Bangalore, Karnataka, India.
BMJ Case Rep. 2014 Apr 9;2014:bcr2014204022. doi: 10.1136/bcr-2014-204022.
Invasive aspergillus and mucormycosis infection are not uncommon in immunocompromised individuals. Endobronchial fungal infections have been reported in the literature, especially in patient's with diabetes complicated by diabetic ketoacidosis, but end bronchial coinfection with aspergillus and mucormycosis without pulmonary involvement has not been described in the literature. We report the case of a woman with diabetes who presented with gastrointestinal symptoms, ketoacidosis and respiratory distress, with an apparently normal chest X-ray. Investigations revealed a cavitatory lesion in the left lower lobe of the lungs on CT scan. Bronchoscopy revealed intense mucosal oedema and whitish plaques at the lower end of the trachea and right main stem bronchus with a normal left bronchial tree. Microbiological and pathological results confirmed aspergillus and mucormycosis. Despite aggressive medical management, the patient deteriorated and died of respiratory failure. Strong suspicion of invasive fungal infections in immunocompromised patients with respiratory failure and minimal chest infiltrates, early fibreoptic bronchoscopy and early aggressive treatment is crucial for the patient's survival.
侵袭性曲霉病和毛霉病感染在免疫功能低下的个体中并不罕见。文献中已报道过支气管内真菌感染，尤其是在合并糖尿病酮症酸中毒的糖尿病患者中，但文献中尚未描述过无肺部受累的支气管曲霉和毛霉二重感染。我们报告了一例患有糖尿病的女性病例，该患者出现胃肠道症状、酮症酸中毒和呼吸窘迫，胸部X线检查结果明显正常。检查发现CT扫描显示左肺下叶有空洞性病变。支气管镜检查显示气管下端和右主支气管有严重的黏膜水肿和白色斑块，左支气管树正常。微生物学和病理学结果证实为曲霉和毛霉感染。尽管进行了积极的药物治疗，患者病情仍恶化，最终死于呼吸衰竭。对于出现呼吸衰竭且胸部浸润轻微的免疫功能低下患者，强烈怀疑侵袭性真菌感染时，早期纤维支气管镜检查和早期积极治疗对患者的生存至关重要。
