de Almeida Júnior João N, Ibrahim Karim Y, Del Negro Gilda M B, Bezerra Evandro D, Duarte Neto Amaro N, Batista Marjorie V, Siciliano Rinaldo F, Giudice Mauro C, Motta Adriana L, Rossi Flávia, Pierrotti Ligia C, Freire Maristela P, Bellesso Marcelo, Pereira Juliana, Abdala Edson, Benard Gil
Laboratory of Medical Mycology (LIM-53), Division of Dermatology Clinic, Hospital das Clínicas da FMUSP and Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil.
Central Laboratory Division (LIM-03), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 - Cerqueira César, São Paulo, 05403-000, Brazil.
Mycopathologia. 2016 Feb;181(1-2):125-9. doi: 10.1007/s11046-015-9936-8. Epub 2015 Sep 7.
Neutropenic patients are at risk of the development of hyalohyphomycosis and mucormycosis. Correct identification is essential for the initiation of the specific treatment, but concomitant mold infections are rarely reported. We report one unprecedented case of concomitant mucormycosis and fusariosis in a neutropenic patient with acute myeloid leukemia. The patient developed rhino-orbital infection by Rhizopus arrhizus and disseminated infection by Fusarium solani. The first culture from a sinus biopsy grew Rhizopus, which was consistent with the histopathology report of mucormycosis. A second sinus biopsy collected later during the patient's clinical deterioration was reported as hyalohyphomycosis, and the culture yielded F. solani. Due to the discordant reports, the second biopsy was reviewed and two hyphae types suggestive of both hyalohyphomycetes and mucormycetes were found. The dual mold infection was confirmed by PCR assays from paraffinized tissue sections. Increased awareness of the existence of dual mold infections in at-risk patients is necessary. PCR methods in tissue sections may increase the diagnosis of dual mold infections. In case of sequential biopsies showing discrepant results, mixed infections have to be suspected.
中性粒细胞减少的患者有发生透明丝孢霉病和毛霉病的风险。正确识别对于开始特异性治疗至关重要，但同时发生的霉菌感染鲜有报道。我们报告了一例急性髓系白血病中性粒细胞减少患者同时发生毛霉病和镰刀菌病的罕见病例。该患者发生了由少根根霉引起的鼻眶感染以及由茄病镰刀菌引起的播散性感染。鼻窦活检的首次培养长出根霉，这与毛霉病的组织病理学报告一致。在患者临床病情恶化期间稍后采集的第二次鼻窦活检报告为透明丝孢霉病，培养结果为茄病镰刀菌。由于报告结果不一致，对第二次活检进行了复查，发现了两种提示透明丝孢菌和毛霉的菌丝类型。通过石蜡包埋组织切片的PCR检测证实了双重霉菌感染。有必要提高对高危患者双重霉菌感染存在情况的认识。组织切片中的PCR方法可能会提高双重霉菌感染的诊断率。如果连续活检结果不一致，必须怀疑混合感染。
