一名糖尿病酮症酸中毒患者的鼻眶脑毛霉菌病：病例报告及文献综述
Rhino-Orbital Cerebral Mucormycosis in a Patient With Diabetic Ketoacidosis: A Case Report and Literature Review.
作者信息
Dong Nan, Jordan Ashly E, Shen Xiaozhu, Wu Xuan, Guo Xianghong, Zhao Hongru, Wang Yajuan, Wang Dapeng, Fang Qi
机构信息
Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Neurology, Suzhou Industrial Park Xinghai Hospital, Suzhou, China.
出版信息
Front Neurol. 2022 May 4;13:815902. doi: 10.3389/fneur.2022.815902. eCollection 2022.
BACKGROUND
Rhino-orbital cerebral mucormycosis (ROCM) is a rare, invasive, and fatal fungal disease. Due to the lack of specific clinical manifestations and adequate auxiliary examinations, patients are easily misdiagnosed in the early stage. Early diagnosis and timely therapy are essential for successful treatment.
CASE REPORT
We report a 68-year-old man with diabetic ketoacidosis, presented with orbital apex syndrome (OAS), fever, and pansinusitis, which progressively worsened to death only 4 days after admission. It was finally confirmed as a fungal infection by metagenomics cell-free DNA next-generation sequencing (mNGS) testing.
CONCLUSION
Orbital apex syndrome could be the initial presentation for mucormycosis. Thus, it is necessary to evaluate the presence of mucormycosis in patients with OAS, especially in diabetic or immunosuppressed hosts, and mNGS testing and timely antifungal therapy should be strongly recommended in highly suspected cases.
背景
鼻眶脑毛霉菌病（ROCM）是一种罕见的、侵袭性的致命真菌疾病。由于缺乏特异性临床表现和充分的辅助检查，患者在早期易被误诊。早期诊断和及时治疗是成功治疗的关键。
病例报告
我们报告一例68岁患有糖尿病酮症酸中毒的男性患者，表现为眶尖综合征（OAS）、发热和全鼻窦炎，入院仅4天后病情逐渐恶化至死亡。最终通过宏基因组无细胞DNA下一代测序（mNGS）检测确诊为真菌感染。
结论
眶尖综合征可能是毛霉菌病的首发表现。因此，有必要评估OAS患者，尤其是糖尿病或免疫抑制宿主中毛霉菌病的存在情况，对于高度怀疑的病例，强烈建议进行mNGS检测并及时进行抗真菌治疗。
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