Kurosawa Shuhei, Sekiya Noritaka, Muraosa Yasunori, Kamei Katsuhiko, Nagata Akihito, Yamada Yuta, Konishi Tatsuya, Takezaki Toshiaki, Kaito Satoshi, Sakaguchi Masahiro, Harada Kaito, Yasuda Shunichiro, Yoshioka Kosuke, Inamoto Kyoko, Toya Takashi, Igarashi Aiko, Najima Yuho, Muto Hideharu, Doki Noriko, Kobayashi Takeshi, Kakihana Kazuhiko, Sakamaki Hisashi, Ohashi Kazuteru
Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital.
Department of Clinical Laboratory, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital.
Rinsho Ketsueki. 2017;58(12):2375-2379. doi: 10.11406/rinketsu.58.2375.
We report three cases of fusariosis that occurred during the treatment of acute leukemia, during the past 5 years at our institution. Case 1: A 70-year-old male with relapsed and refractory acute lymphoblastic leukemia (ALL) developed fever and multiple nodular lesions in both the lungs. Blood culture that was subsequently obtained revealed Fusarium species. Treatment with liposomal-amphotericin B (L-AMB) was ineffective, and the condition of the patient deteriorated rapidly leading to death. Case 2: A 28-year-old male with T-ALL developed echthyma gangrenosum (EG) ulcers on the scrotum during conditioning for transplantation. Antifungal therapy with L-AMB was ineffective, and later, itraconazole and micafungin (MCFG) were introduced. However, the engraftment was not achieved, and the patient died on day 27. Microbiological examination of EG samples collected on day 13 revealed infection by Fusarium species post mortem. Case 3: A 50-year-old male with blast crisis of chronic myeloid leukemia developed EG primarily on the trunk during chemotherapy. The patient died without any response to L-AMB and MCFG. A culture obtained from EG on day 19 yielded Fusarium species, post mortem. The prognosis of fusariosis is extremely poor. However, skin lesions such as EG may assist in the early diagnosis of the disseminated disease.
我们报告了过去5年在我们机构治疗急性白血病期间发生的3例镰刀菌病病例。病例1：一名70岁男性，患有复发难治性急性淋巴细胞白血病（ALL），出现发热和双肺多发结节性病变。随后进行的血培养显示为镰刀菌属。使用脂质体两性霉素B（L-AMB）治疗无效，患者病情迅速恶化导致死亡。病例2：一名28岁男性，患有T-ALL，在移植预处理期间阴囊出现坏疽性脓皮病（EG）溃疡。使用L-AMB进行抗真菌治疗无效，随后引入伊曲康唑和米卡芬净（MCFG）。然而，未实现植入，患者在第27天死亡。对第13天采集的EG样本进行微生物检查，死后显示为镰刀菌属感染。病例3：一名50岁男性，患有慢性髓性白血病急变期，在化疗期间主要在躯干出现EG。患者对L-AMB和MCFG无反应，最终死亡。第19天从EG获取的培养物，死后培养出镰刀菌属。镰刀菌病的预后极差。然而，诸如EG之类的皮肤病变可能有助于播散性疾病的早期诊断。
