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[手术在一名急性髓系白血病患者头状腐质霉(S. capitata)败血症中的作用]

[Role of surgery in Saprochaete capitata (S. capitata) sepsis in a patient with acute myeloid leukemia].

作者信息

Radich R Jasna, Álvarez Z Carlos, Valenzuela R Ana, Castillo H Felipe, Moraga V Francisco, Castillo A Jorge

机构信息

Departamento de Cirugía, Universidad de Chile, Santiago, Chile.

Servicio de Cirugía, Hospital Barros Luco Trudeau, Santiago, Chile.

出版信息

Rev Med Chil. 2017 Aug;145(8):1067-1071. doi: 10.4067/s0034-98872017000801067.

Abstract

Saprochaete capitata (S. capitata) fungal sepsis is a severe condition with a clinical presentation that is similar to other yeast originated fungal sepsis. It is observed in patients with hematological malignancies such as acute myeloid leukemia and neutropenia. We report a 23 year old male presenting with cough, fever and malaise. A bone marrow biopsy led to the diagnosis of acute myeloid leukemia. During the first cycle of chemotherapy the patient presented fever: blood cultures were positive for Klebsiella pneumoniae. Despite antimicrobial treatment, fever persisted; a computed tomography showed a focal splenic lesion; a left exudative pleural effusion appeared. A Matrix Assisted Laser Desorption Ionization-Time of Flight mass spectrometry identified the presence of S. capitata. After multiple antifungal treatments and pleural cavity cleansing by means of videothoracoscopy and laparoscopic splenectomy, the infection resolved and the patient completed his chemotherapy.

摘要

头状腐质霉(S. capitata)真菌败血症是一种严重病症,其临床表现与其他酵母源性真菌败血症相似。在患有血液系统恶性肿瘤(如急性髓系白血病)和中性粒细胞减少症的患者中可见。我们报告一名23岁男性,出现咳嗽、发热和全身不适症状。骨髓活检诊断为急性髓系白血病。在化疗的第一个周期中,患者出现发热:血培养肺炎克雷伯菌呈阳性。尽管进行了抗菌治疗,但发热仍持续;计算机断层扫描显示脾脏有局灶性病变;出现左侧渗出性胸腔积液。基质辅助激光解吸电离飞行时间质谱法鉴定出头状腐质霉的存在。经过多次抗真菌治疗以及通过电视胸腔镜和腹腔镜脾切除术进行胸腔清理后,感染得到解决,患者完成了化疗。

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