Gologorsky Rebecca C, Ely Sora, Rothenberg Kara A, Glaser Carol, Velotta Jeffrey B
Department of Surgery, University of California San Francisco- East Bay, 1411 East 31st Street, Oakland, CA, 94602, USA.
Department of Infectious Disease, Kaiser Oakland Medical Center, 3600 Broadway, Oakland, CA 94611, USA.
J Pediatr Surg Case Rep. 2019 Jun;45. doi: 10.1016/j.epsc.2019.101210. Epub 2019 Apr 24.
Mucor is a ubiquitous fungus that is non-pathogenic in healthy people. In immunocompromised hosts, non-functional or absent neutrophils and macrophages result in fungal invasion and infection [1]. Invasive mucor (mucormycosis) most commonly involves the sinuses, brain, or lungs. Pulmonary mucormycosis typically presents in patients with a history of organ transplantation or hematologic malignancy [2], and is rare in patients with diabetes alone. The epidemiology and management of pediatric pulmonary mucormycosis is poorly described. We report an unusual occurrence of this disease, complicated by segmental pulmonary artery thrombus in a 15-year-old with poorly controlled diabetes. His severe, medication-resistant infection was ultimately treated successfully with antifungal medication combined with aggressive surgical debridement. The pulmonary artery segmental thrombus resolved after treatment of the underlying infection without anticoagulation.
毛霉是一种普遍存在的真菌,在健康人群中不具有致病性。在免疫功能低下的宿主中,中性粒细胞和巨噬细胞功能失调或缺乏会导致真菌侵袭和感染[1]。侵袭性毛霉病(毛霉菌病)最常累及鼻窦、大脑或肺部。肺毛霉菌病通常见于有器官移植或血液系统恶性肿瘤病史的患者[2],而仅患有糖尿病的患者中较为罕见。儿童肺毛霉菌病的流行病学和治疗方法鲜有描述。我们报告了一名15岁糖尿病控制不佳的患者发生这种疾病的罕见病例,该病例并发节段性肺动脉血栓形成。他严重的、药物难治性感染最终通过抗真菌药物联合积极的手术清创成功治愈。在基础感染得到治疗后,肺动脉节段性血栓在未进行抗凝治疗的情况下得以消退。