Fujiwara Yuki, Tobita Haruna, Mochizuki Naoya, Inomata Tomoko, Asano Takeru, Ohishi Hirokazu, Kanamitsu Hitoshi, Kubonishi Shiro, Mohri Makoto, Hiramatsu Yasushi
Department of Hematology and Oncology, Japanese Red Cross Society Himeji Hospital.
Department of Inspection Technology, Japanese Red Cross Society Himeji Hospital.
Rinsho Ketsueki. 2022;63(7):740-745. doi: 10.11406/rinketsu.63.740.
A 62-year-old female was presented to the hospital of the current study for pancytopenia and was diagnosed with severe aplastic anemia. She was treated with a combination therapy of antithymocyte globulin, cyclosporine A, and eltrombopag. The patient also presented with febrile neutropenia after commencement of the treatment and did not respond to the various antibiotics and antifungal agents. Echocardiography showed a giant vegetation attached to the tricuspid valve on Day 78 of the immunosuppressive therapy, and the tricuspid valve replacement was performed. The vegetation was formed by Cunninghamella bertholletiae, a mucor type, and was treated with high-dose liposomal amphotericin B (L-AMB), which was terminated after six weeks due to decreased renal function. In addition, mucormycosis was controlled by posttreatment with posaconazole (PSCZ). This is a rare case of mucormycosis that developed into a giant vegetation during the immunosuppressive therapy for aplastic anemia. It was believed to be a valuable case to consider in future mucormycosis treatment, including the success of the treatment by switching from L-AMB to PSCZ.
一名62岁女性因全血细胞减少症入住本研究所在医院，被诊断为严重再生障碍性贫血。她接受了抗胸腺细胞球蛋白、环孢素A和艾曲泊帕的联合治疗。患者在治疗开始后还出现了发热性中性粒细胞减少症，对各种抗生素和抗真菌药物均无反应。免疫抑制治疗第78天时，超声心动图显示三尖瓣上有一个巨大赘生物，遂进行了三尖瓣置换术。该赘生物由毛霉属的柏氏根霉形成，采用高剂量脂质体两性霉素B（L-AMB）治疗，因肾功能下降，六周后停药。此外，泊沙康唑（PSCZ）治疗后控制了毛霉病。这是一例罕见的毛霉病病例，在再生障碍性贫血免疫抑制治疗期间发展为巨大赘生物。这被认为是未来毛霉病治疗中值得考虑的一个有价值的病例，包括从L-AMB转换为PSCZ治疗成功的案例。
