Itoh Masahito, Oki Masayuki, Yanagi Hidetaka, Oka Akiko, Tajiri Sakurako, Fukuda Ryuki, Ozawa Hideki, Takagi Atsushi
Kansenshogaku Zasshi. 2014 Nov;88(6 Suppl 11):7-10.
We report the case of a 63-year-old man who presented at our hospital after experiencing fever and dyspnea for more than 1 month. Because his general condition was deteriorating, he was referred to our intensive care unit. He needed critical care and was treated with vasopressors, artificial ventilation, and continuous hemodialysis. Considering his systemic condition, hematological malignancy was suspected. Bone marrow and skin biopsies were performed, and the condition was diagnosed as diffuse large B-cell lymphoma. On the 15th day, suspecting infectious lung disease, we performed bronchoscopy, which showed Rhizopus infection. Thus, the patient was administered high- dose liposomal amphotericin B (10 mg/kg) therapy. On the 54th day, he died of a massive pulmonary hemorrhage. Autopsy revealed mucormycosis infection in multiple organs, including the lungs and liver. Vigilance regarding possible mucormycosis infection is required, even after initial chemotherapy in patients whose bone marrow is significantly affected by lymphoma cells and leukemic changes.
我们报告了一例63岁男性病例，该患者在出现发热和呼吸困难1个多月后到我院就诊。由于其一般状况不断恶化，他被转诊至我院重症监护病房。他需要重症监护，并接受了血管加压药、人工通气和持续血液透析治疗。考虑到他的全身状况，怀疑患有血液系统恶性肿瘤。进行了骨髓和皮肤活检，诊断为弥漫性大B细胞淋巴瘤。在第15天，怀疑有感染性肺部疾病，我们进行了支气管镜检查，结果显示为根霉菌感染。因此，给予患者高剂量脂质体两性霉素B（10mg/kg）治疗。在第54天，他死于大量肺出血。尸检显示包括肺和肝在内的多个器官存在毛霉菌感染。对于骨髓受到淋巴瘤细胞和白血病变化显著影响的患者，即使在初始化疗后，也需要警惕可能的毛霉菌感染。
