Chen Qiong, Chen Kuang, Qian Shenxian, Wu Shenghai, Xu Lihui, Huang Xilian, Shi Pengfei, Wang Kaile, Wang Minmin, Wang Xianjun
Department of Laboratory Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China.
Department of Hematology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China.
Exp Ther Med. 2019 Nov;18(5):4076-4080. doi: 10.3892/etm.2019.8065. Epub 2019 Sep 27.
Mucormycosis is an angioinvasive fungal infection with a high mortality rate. Patients with hematological malignancies following voriconazole therapy are at high risk from mucormycosis. Here, the present study reports on a 68-year-old man diagnosed with multiple myeloma and secondary myelodysplastic syndrome, who was infected with disseminated mucormycosis with cerebellum involvement confirmed by mycological culture and histopathological examination. For patients with hematological malignancies who are receiving antifungal therapy, an opportunistic infection of mucormycosis should be considered if a 'breakthrough' infection occurs in the predilection sites (such as the sinuses, lungs, skin, brain and gastrointestinal tract). It is difficult to diagnose mucormycosis because of the limited reliable detection methods, and because mucormycosis often presents with an acute onset and progresses rapidly, particularly in immunocompromised patients. Antifungal therapy with amphotericin B or posaconazole should be started as soon as possible considering the empirical diagnosis.
毛霉菌病是一种具有高死亡率的血管侵袭性真菌感染。接受伏立康唑治疗的血液系统恶性肿瘤患者发生毛霉菌病的风险很高。在此,本研究报告了一名68岁男性,诊断为多发性骨髓瘤和继发性骨髓增生异常综合征,经真菌培养和组织病理学检查确诊为播散性毛霉菌病并累及小脑。对于正在接受抗真菌治疗的血液系统恶性肿瘤患者,如果在好发部位(如鼻窦、肺、皮肤、脑和胃肠道)发生“突破性”感染,应考虑毛霉菌病这一机会性感染。由于可靠的检测方法有限,且毛霉菌病通常起病急、进展快,尤其是在免疫功能低下的患者中,因此毛霉菌病难以诊断。考虑到经验性诊断,应尽快开始使用两性霉素B或泊沙康唑进行抗真菌治疗。