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一名免疫功能正常男性的孤立性肾毛霉菌病致死病例。

A Fatal Case of Isolated Renal Mucormycosis in an Immunocompetent Male.

作者信息

Healey Kevin D, Phrathep Davong D, Anthony Stefan, Jenkins Michael A, Gentchev Lynda, Rifai Ahmad O

机构信息

College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA.

Urology, Advanced Urology Institute, Panama City, USA.

出版信息

Cureus. 2022 Sep 26;14(9):e29593. doi: 10.7759/cureus.29593. eCollection 2022 Sep.

Abstract

Mucormycosis (MM) is an angio-invasive fungal infection that often presents in immunocompromised patients. Isolated renal MM is an uncommon presentation that has been documented as a life-threatening condition in immunocompetent patients due to its poor prognosis. Here, we present a rare case of isolated renal MM in a 27-year-old male who presented with left flank pain, nausea, and vomiting. Upon further investigation, a renal infarct was discovered, and he underwent a subsequent nephrectomy. A renal biopsy revealed MM. The patient's infection spread, and he ultimately succumbed to his illness. Isolated renal involvement of this pathogen is extremely rare in healthy individuals and has poor outcomes. The ubiquitous nature of MM increases the risk of exposure to humans. Comorbidities such as coronavirus disease 2019 and immunosuppressive states are risk factors for the deleterious outcomes of MM. It is unusual for an immunocompetent patient with no underlying conditions to die despite early diagnosis and prompt treatment. This example calls attention to the unpredictable clinical presentation of isolated renal MM. Our case highlights MM as a differential diagnosis in patients with unilateral flank pain and identifies the importance of a prompt clinical diagnosis and treatment due to the rapid progression and poor health outcomes associated with MM infection.

摘要

毛霉菌病(MM)是一种血管侵袭性真菌感染,常见于免疫功能低下的患者。孤立性肾毛霉菌病是一种不常见的表现形式,在免疫功能正常的患者中,因其预后较差,已被记录为一种危及生命的疾病。在此,我们报告一例罕见的27岁男性孤立性肾毛霉菌病病例,该患者表现为左侧胁腹痛、恶心和呕吐。进一步检查发现肾梗死,随后他接受了肾切除术。肾活检显示为毛霉菌病。患者的感染扩散,最终因病死亡。这种病原体在健康个体中孤立累及肾脏极为罕见,且预后不良。毛霉菌病的普遍存在增加了人类接触的风险。2019冠状病毒病等合并症和免疫抑制状态是毛霉菌病产生有害后果的危险因素。对于一名无基础疾病的免疫功能正常患者,尽管早期诊断并及时治疗仍死亡,这种情况并不常见。这个例子提醒人们注意孤立性肾毛霉菌病不可预测的临床表现。我们的病例强调毛霉菌病是单侧胁腹痛患者的鉴别诊断之一,并指出由于毛霉菌病感染进展迅速且健康结局不佳,及时临床诊断和治疗的重要性。

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