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一名系统性红斑狼疮患者的肺毛霉菌病:诊断与治疗挑战

Pulmonary Mucormycosis in a Patient with Systemic Lupus Erythematosus: A Diagnostic and Treatment Challenge.

作者信息

Hung Hung-Chang, Shen Gang-Yu, Chen Shiuan-Chih, Yeo Kai-Jieh, Tsao Shih-Ming, Lee Meng-Chih, Lee Yuan-Ti

机构信息

Division of Gastroenterology, Department of Internal Medicine, Nantou Hospital, Ministry of Health and Welfare, No. 478, Fuxing Road, Nantou City, Nantou County 540, Taiwan.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chiu General Hospital, No. 137, Chenggong First Road, Lingya District, Kaohsiung 802, Taiwan.

出版信息

Case Rep Infect Dis. 2015;2015:478789. doi: 10.1155/2015/478789. Epub 2015 Jun 22.

Abstract

Pulmonary mucormycosis is commonly encountered in patients with diabetic ketoacidosis, hematologic malignancies, neutropenia, organ or hematopoietic stem cell transplantation, and malignancy, but it rarely occurs in high-risk patients with systemic lupus erythematosus (SLE). We present the case of a 40-year-old SLE female with fulminant pneumonia after remission of nephritis treated with rituximab, who developed severe pulmonary mucormycosis that led to her rapid death from acute respiratory failure and acute respiratory distress syndrome. Pulmonary mucormycosis has a high mortality rate. However, with early diagnosis and antifungal therapy with lipid formulation-liposomal amphotericin B and surgical removal of the infected area, the outcome can be improved.

摘要

肺毛霉病常见于糖尿病酮症酸中毒、血液系统恶性肿瘤、中性粒细胞减少症、器官或造血干细胞移植以及恶性肿瘤患者,但在系统性红斑狼疮(SLE)高危患者中很少发生。我们报告了一例40岁的SLE女性患者,在用利妥昔单抗治疗肾炎缓解后发生暴发性肺炎,继而发展为严重的肺毛霉病,最终因急性呼吸衰竭和急性呼吸窘迫综合征迅速死亡。肺毛霉病死亡率很高。然而,通过早期诊断并使用脂质体制剂——脂质体两性霉素B进行抗真菌治疗以及手术切除感染区域,预后可能会得到改善。

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