Navarro Vergara Dulce Iliana, Barragán Pola Gloria, Bonifaz Alexandro, Núñez Pérez-Redondo Carlos, Choreño García Omar, Cicero Sabido Raúl
Servicio de Neumología, Hospital General de México «Dr. Eduardo Liceaga», Ciudad de México, México.
Departamento de Micología, Hospital General de México «Dr. Eduardo Liceaga», Ciudad de México, México.
Rev Iberoam Micol. 2017 Oct-Dec;34(4):233-236. doi: 10.1016/j.riam.2017.03.005. Epub 2017 Jul 27.
Pulmonary mucormycosis is a rare opportunistic infection with high mortality that is caused by species of Mucorales. The most common species involved are Rhizopus, Mucor, Lichtheimia, and Rhizomucor.
A 56 year-old woman presented with a clinical history of diabetes mellitus type 2 and chronic renal disease. She underwent a cadaveric kidney transplantation two years before her admission, for which immunomodulating therapy with thymoglobulin, tacrolimus, mofetil-microphenolate and prednisone was established. The patient suffered a pneumonic process with cough, expectoration, and dyspnoea. The computed tomography scan showed a cavitation in the right upper lobe. With all these findings an invasive broncopulmonary aspergillosis was suspected and the patient began an antifungal treatment with voriconazole without improvement. Rhizomucor pusillus was isolated from a clinical specimen obtained by fine needle aspiration, and its identification was confirmed by PCR. After this finding amphotericin B was administered, but the patient had an uncontrolled haemoptysis and died.
Pulmonary mucormycosis is a rare infection, usually fatal in kidney transplant recipients with anti-rejection therapy. Mucorales species usually produce thrombotic phenomena, associated with necrosis and parenchymal destruction that caused a fatal uncontrolled haemoptysis in our patient. Early diagnosis is important in order to perform any surgical treatment and to administer amphotericin B.
肺毛霉病是一种由毛霉目真菌引起的罕见机会性感染，死亡率很高。最常见的致病菌种为根霉属、毛霉属、犁头霉属和根毛霉属。
一名56岁女性，有2型糖尿病和慢性肾病病史。入院前两年接受了尸体肾移植，为此采用了胸腺球蛋白、他克莫司、霉酚酸酯和泼尼松进行免疫调节治疗。患者出现了伴有咳嗽、咳痰和呼吸困难的肺部病变。计算机断层扫描显示右上叶有空洞形成。基于所有这些发现，怀疑为侵袭性支气管肺曲霉病，患者开始使用伏立康唑进行抗真菌治疗，但病情无改善。从细针穿刺获取的临床标本中分离出微小根毛霉，并通过聚合酶链反应确认了其鉴定结果。发现这一情况后，给予了两性霉素B治疗，但患者出现了难以控制的咯血并死亡。
肺毛霉病是一种罕见的感染，在接受抗排斥治疗的肾移植受者中通常是致命的。毛霉目真菌通常会产生血栓形成现象，伴有坏死和实质破坏，这导致了我们的患者出现致命的难以控制的咯血。早期诊断对于进行任何手术治疗和给予两性霉素B都很重要。
