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系统性红斑狼疮患者的侵袭性上颌曲霉病:病例报告

Invasive maxillary aspergillosis in a patient with systemic lupus erythematosus: Case report.

作者信息

Dachlan Ishandono, Wicaksana Aditya, Fauzi Aditya Rifqi, Wahdini Siti Isya, Vityadewi Nurardhilah, Seswandhana Muhammad Rosadi, Lutfianto Muhammad Bakhrul, Pradana Franciscus Wihan

机构信息

Plastic Reconstructive and Aesthetic Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia.

Department of Oral and Maxillofacial Surgery, Faculty of Dentistry/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia.

出版信息

Ann Med Surg (Lond). 2020 Sep 1;58:44-47. doi: 10.1016/j.amsu.2020.08.031. eCollection 2020 Oct.

Abstract

INTRODUCTION

Invasive aspergillosis (IA) is a fungal infection caused by Aspergillus species (spp.). Aspergillosis is the most common source of opportunistic fungal infection in humans. IA can cause serious complications related to high morbidity and mortality in immunocompromised patients.

PRESENTATION OF CASE

We report a case of a 22-year-old female with a chief complaint of having a hole in the roof of her mouth. She was diagnosed with SLE in 2009. She had been consuming oral methylprednisolone ever since. In 2018, she experienced worsened symptoms and was hospitalized. She experienced swelling and bleeding of her gums and some of her teeth becoming loose and falling out, and then developing a hole in the roof of her mouth. Subsequently, she was treated with oral cyclophosphamide, oral mycophenolate sodium, and oral fluconazole. She was asked to stop taking oral methylprednisolone. In 2019, the palate biopsy was performed and showed spp. invading the palate. Afterward, the patient was referred to our clinic for defect closure. The patient was operated on for debridement and reconstruction of the defect. There was no recurrence of the defect or complications observed in the follow-up. The patient was satisfied with the surgical results.

DISCUSSION

IA is a destructive and potentially harmful opportunistic fungal infection and treatments with surgical interventions should be well-thought-out in immunocompromised patients.

CONCLUSION

The management of IA are controlling any underlying diseases and surgical debridement or necrotomy. Generally, antifungal therapy and prompt surgical intervention are successful in managing invasive aspergillosis.

摘要

引言

侵袭性曲霉病(IA)是由曲霉菌种引起的真菌感染。曲霉病是人类机会性真菌感染最常见的来源。IA可导致免疫功能低下患者出现与高发病率和死亡率相关的严重并发症。

病例介绍

我们报告一例22岁女性,主要诉求为口腔顶部有一个洞。她于2009年被诊断为系统性红斑狼疮(SLE)。从那时起她一直在服用口服甲泼尼龙。2018年,她症状加重并住院。她出现牙龈肿胀、出血,部分牙齿松动脱落,随后口腔顶部出现一个洞。随后,她接受了口服环磷酰胺、口服麦考酚钠和口服氟康唑治疗。她被要求停止服用口服甲泼尼龙。2019年,进行了腭部活检,显示有曲霉菌种侵犯腭部。此后,患者被转诊至我们的诊所进行缺损修复。患者接受了清创和缺损重建手术。随访中未观察到缺损复发或并发症。患者对手术结果满意。

讨论

IA是一种具有破坏性且潜在有害的机会性真菌感染,对于免疫功能低下患者实施手术干预治疗应深思熟虑。

结论

IA的治疗方法包括控制任何潜在疾病以及手术清创或坏死组织切除术。一般来说,抗真菌治疗和及时的手术干预对于治疗侵袭性曲霉病是成功的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2528/7484496/4154b4c1b589/gr1.jpg

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