Valle Ana, Tagoe Clement
Division of Internal Medicine, Montefiore Medical Center, Bronx, USA.
Division of Rheumatology, Montefiore Medical Center, Bronx, USA.
Cureus. 2023 Feb 13;15(2):e34941. doi: 10.7759/cureus.34941. eCollection 2023 Feb.
Microscopic polyangiitis (MPA) is a rare antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis marked by renal involvement, which often leads to rapidly progressive glomerulonephritis. Immunosuppressive treatment is necessary to prevent irreparable organ damage. On the other hand, mucormycosis is a rare and devastating opportunistic fungal infection with a high mortality rate in both immunosuppressed and immunocompetent individuals. It requires a high index of suspicion at the time of diagnosis since any delay in treatment may lead to severe morbidity or death. Here, we present the case of a diabetic patient diagnosed with MPA who received partial induction treatment, subsequently developed mucormycosis, survived, yet required continued immunosuppressive treatment for active MPA while imaging was concerning for a persistent mucormycosis infection. This case highlights the barriers to early mucormycosis detection specific to vasculitis patients, mucormycosis considerations unique to the rheumatologic population, and discusses how to balance immunosuppressive treatment in the setting of a deadly opportunistic infection.
显微镜下多血管炎（MPA）是一种罕见的抗中性粒细胞胞浆抗体（ANCA）相关性血管炎，其特征为肾脏受累，常导致快速进展性肾小球肾炎。免疫抑制治疗对于预防不可修复的器官损害是必要的。另一方面，毛霉病是一种罕见且具有破坏性的机会性真菌感染，在免疫抑制和免疫功能正常的个体中死亡率都很高。诊断时需要高度怀疑，因为任何治疗延迟都可能导致严重的发病或死亡。在此，我们报告一例糖尿病患者，该患者被诊断为MPA，接受了部分诱导治疗，随后发生了毛霉病，存活下来，但在影像学检查显示毛霉病持续感染的情况下，仍需要继续接受免疫抑制治疗以控制活动性MPA。该病例突出了血管炎患者早期检测毛霉病的障碍、风湿病患者特有的毛霉病相关考量，并讨论了在致命性机会性感染情况下如何平衡免疫抑制治疗。
