Shintaku Masayuki, Yamada Eiji, Ohta Makoto, Yoshikawa Kohei
Department of Pathology, Hikone Municipal Hospital Shiga, Japan.
Otsu Laboratory of Diagnostic Pathology Shiga, Japan.
Int J Clin Exp Pathol. 2022 May 15;15(5):233-237. eCollection 2022.
We report the autopsy findings of a case of disseminated mucormycosis caused by , a rare pathogenic fungus of the family . The patient was a 49-year-old woman with B-lymphoblastic leukemia with hyperdiploidy, who died of progressive heart failure 4 months after induction chemotherapy successfully brought about complete remission of the leukemia. Granulocyte colony-stimulating factor (G-CSF) had been administered along with anti-neoplastic drugs, and her blood neutrophil count was markedly elevated. Autopsy revealed disseminated mycotic thromboembolism and abscess formation in the heart, lung, liver, kidney, and spleen. The most marked feature was a large mural thrombus in the left ventricle containing numerous fungal hyphae. In the myocardium and disseminated foci in visceral organs, giant cell-rich, fibrotic reactions to the mycotic infection were observed. Both the formation of a large intra-ventricular mural thrombus and giant cell reactions are rare findings in mucormycosis. We considered that the recovery and marked increase in neutrophil count induced by chemotherapy and G-CSF administration prolonged the clinical course and pathologically elicited an atypical, giant cell reaction to the mycotic infection. The prolonged clinical course also contributed to the formation of an unusually large intra-ventricular mural thrombus.
我们报告了一例由毛霉科一种罕见致病真菌引起的播散性毛霉病的尸检结果。患者为一名49岁患有超二倍体B淋巴细胞母细胞白血病的女性，在诱导化疗成功使白血病完全缓解4个月后死于进行性心力衰竭。在给予抗肿瘤药物的同时还使用了粒细胞集落刺激因子（G-CSF），她的血液中性粒细胞计数显著升高。尸检发现心脏、肺、肝、肾和脾脏有播散性真菌性血栓栓塞和脓肿形成。最显著的特征是左心室有一个大的壁血栓，其中含有大量真菌菌丝。在心肌和内脏器官的播散病灶中，观察到对真菌感染的富含巨细胞的纤维化反应。在毛霉病中，形成大的室内壁血栓和巨细胞反应都是罕见的发现。我们认为化疗和G-CSF给药诱导的中性粒细胞计数恢复和显著增加延长了临床病程，并在病理上引发了对真菌感染的非典型巨细胞反应。延长的临床病程也促成了异常大的室内壁血栓的形成。
