Davuodi Setareh, Manshadi Seyed Ali Dehghan, Salehi Mohammad Reza, Yazdi Farhad, Khazravi Mona, Fazli Jafar Taghizade
From the Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Exp Clin Transplant. 2015 Feb;13(1):82-5. doi: 10.6002/ect.2013.0216. Epub 2014 Nov 5.
Mucormycosis is an uncommon opportunistic infection that is caused by Mucorales from the Zygomycetes class. Patients with severe immunodeficiency admitted to the hospital are at greatest risk for developing this infection. Mucormycosis usually is transmitted in humans by inhalation or inoculation of spores in the skin or mucous membranes. A 66-year-old man developed a surgical wound infection at 1 week after kidney transplant that did not improve despite broad-spectrum antibiotics and debridement. He was transferred to our hospital 45 days after transplant and had fever and a large purulent wound that was surrounded by a black necrotizing margin. Immunosuppressive drugs were discontinued and the dosage of prednisolone was decreased. Massive debridement was performed but was incomplete because he had full-thickness abdominal wall necrosis. Histopathology showed broad fungal hyphae without septation, consistent with the diagnosis of mucormycosis. Despite antifungal therapy with amphotericin B and additional debridement, the patient died of septic shock at 52 days after kidney transplant. Cutaneous fungal infections should be considered in the differential diagnosis of any nonhealing infected wound that does not respond to broad-spectrum antibiotics, especially in patients with predisposing risk factors such as transplant.
毛霉病是一种由接合菌纲毛霉目真菌引起的罕见机会性感染。入院的严重免疫缺陷患者发生这种感染的风险最高。毛霉病通常通过吸入或皮肤或黏膜接种孢子在人类中传播。一名66岁男性在肾移植术后1周出现手术伤口感染，尽管使用了广谱抗生素并进行了清创，但病情仍未改善。移植后45天，他被转至我院，出现发热，伤口有大量脓性分泌物，周围有黑色坏死边缘。停用免疫抑制药物并减少泼尼松龙剂量。进行了广泛的清创，但由于他存在全层腹壁坏死，清创并不彻底。组织病理学显示有宽而无分隔的真菌菌丝，符合毛霉病的诊断。尽管使用两性霉素B进行抗真菌治疗并再次清创，但患者在肾移植术后52天死于感染性休克。对于任何对广谱抗生素无反应的不愈合感染伤口，尤其是有移植等易感危险因素的患者，在鉴别诊断时应考虑皮肤真菌感染。
