Boddu Prajwal, Chen Pei-Ling, Nagarajan Priyadharsini, Prieto Victor G, Won Alex, Chambers Mark, Kornblau Steven
Department of Leukemia, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas.
Department of Pathology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas.
J Oral Maxillofac Surg Med Pathol. 2018 Jan;30(1):50-54. doi: 10.1016/j.ajoms.2017.08.007. Epub 2017 Sep 12.
Oral fungal infections present with atypical and varied manifestations, and distinguishing them from other entities including leukemic infiltration can be diagnostically challenging. In this report, we describe a 62 year old female with acute myeloid leukemia who presented, towards the end of her second treatment cycle of decitabine in a prolonged neutropenic state, with a month of painful, necrotic-appearing marginal gingival lesions. She was duly initiated on empiric broad spectrum antifungal treatment but did not show a clinical response with the appearance of new skin lesions concerning for progressive fungemia. Concurrent gingival and cutaneous biopsy showed fungal invasion with . Despite changing antifungal treatment the lesions progressed, and white blood cell (WBC) transfusions were instituted. The patient had an impressive response with gradual resolution of the skin lesions and regression in gingival lesions over a week of therapy. This case illustrates the highly atypical, confounding appearance of oral fungal infections in immunocompromised hematological malignancy patients. Maxillary and mandibular marginal gingival involvement, although extremely rare, should be recognized as potential sites of fungal involvement. Accurate diagnosis entails a biopsy especially in ambiguous clinical scenarios, as presented here. The role of WBC transfusions in the management of these rare fungal pathogenic infections needs to re-established.
口腔真菌感染表现出非典型和多样的症状，将它们与包括白血病浸润在内的其他病症区分开来在诊断上具有挑战性。在本报告中，我们描述了一名62岁的急性髓系白血病女性患者，在接受地西他滨第二个治疗周期接近尾声时，处于长期中性粒细胞减少状态，出现了为期一个月的疼痛性、边缘牙龈坏死样病变。她被及时开始经验性广谱抗真菌治疗，但未显示临床反应，同时出现了提示进行性真菌血症的新皮肤病变。牙龈和皮肤同步活检显示有真菌侵袭。尽管更换了抗真菌治疗，病变仍进展，于是进行了白细胞（WBC）输血。经过一周的治疗，患者有显著反应，皮肤病变逐渐消退，牙龈病变也有所好转。该病例说明了免疫功能低下的血液系统恶性肿瘤患者口腔真菌感染的高度非典型、混淆外观。上颌和下颌边缘牙龈受累虽然极为罕见，但应被视为真菌累及的潜在部位。准确诊断需要活检，尤其是在此处呈现的不明确临床情况下。白细胞输血在这些罕见真菌病原体感染管理中的作用需要重新确定。
