Ochi Yotaro, Hiramoto Nobuhiro, Takegawa Hiroshi, Yonetani Noboru, Doi Asako, Ichikawa Chihiro, Imai Yukihiro, Ishikawa Takayuki
Department of Hematology, Kobe City Medical Center General Hospital, 2-2, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
Int J Hematol. 2015 Jun;101(6):620-5. doi: 10.1007/s12185-015-1752-x. Epub 2015 Jan 29.
Disseminated Scedosporium prolificans infection occurs mainly in immunocompromised patients. The mortality rate is high, as the fungus is resistant to most antifungal agents. Here, we present the case of a 66-year-old female with acute myeloid leukemia who developed infective endocarditis caused by S. prolificans infection during induction chemotherapy. Her 1,3-β-D-glucan levels were elevated and computed tomography revealed bilateral sinusitis and disseminated small nodular masses within the lungs and spleen; it nonetheless took 6 days to identify S. prolificans by blood culture. The patient died of multi-organ failure despite the combined use of voriconazole and terbinafine. Autopsy revealed numerous mycotic emboli within multiple organs (caused by mitral valve vegetation) and endocarditis (caused by S. prolificans). The geographic distribution of this infection is limited to Australia, the United States, and southern Europe, particularly Spain. The first Japanese case was reported in 2011, and four cases have been reported to date, including this one. Recently, the incidence of S. prolificans-disseminated infection in immunocompromised patients has increased in Japan. Therefore, clinicians should consider S. prolificans infection as a differential diagnosis when immunocompromised patients suffer disseminated infections with elevated 1,3-β-D-glucan levels.
播散性多育赛多孢菌感染主要发生在免疫功能低下的患者中。由于该真菌对大多数抗真菌药物耐药，故死亡率很高。在此，我们报告一例66岁急性髓系白血病女性患者，在诱导化疗期间发生了由多育赛多孢菌感染引起的感染性心内膜炎。她的1,3-β-D-葡聚糖水平升高，计算机断层扫描显示双侧鼻窦炎以及肺和脾内有散在的小结节状肿块；尽管如此，血培养确定多育赛多孢菌仍花了6天时间。尽管联合使用了伏立康唑和特比萘芬，患者仍死于多器官功能衰竭。尸检发现多个器官内有大量真菌栓子（由二尖瓣赘生物引起）和心内膜炎（由多育赛多孢菌引起）。这种感染的地理分布仅限于澳大利亚、美国和南欧，尤其是西班牙。日本首例病例于2011年报告，迄今为止包括本例在内共报告了4例。最近，日本免疫功能低下患者中多育赛多孢菌播散性感染的发生率有所增加。因此，当免疫功能低下患者发生1,3-β-D-葡聚糖水平升高的播散性感染时，临床医生应将多育赛多孢菌感染作为鉴别诊断之一。
