Chan Stephanie, Kemp Ursula, Peeceeyen Sheen C
Department of Cardiothoracic Surgery, St George Hospital, Kogarah NSW 2217, Australia.
J Surg Case Rep. 2023 Mar 25;2023(3):rjad123. doi: 10.1093/jscr/rjad123. eCollection 2023 Mar.
A 77-year-old woman underwent surgical aortic valve replacement via hemisternotomy. Her post-operative course was unremarkable. Owing to travel and contact restrictions during the COVID pandemic, she was unable to attend routine follow up. She continued review with her local medical officer in regional New South Wales. Post 6 months following her index surgery, she was referred to the Infectious Disease Clinic of her local hospital with a non-healing lesion at the base of her hemi-sternotomy wound. Computed tomography revealed a deep sternal wound infection which extended deep to bone. She was admitted to hospital for treatment. The primary pathogen identified was Lomentospora prolificans-a dangerous fungus that affects immunosuppressed patients. Strong antifungal and adjunctive antibiotics did not contribute much to clearance of infection. Radical surgical debridement was required to obtain clean tissue margins.
一名77岁女性通过半胸骨切开术接受了主动脉瓣置换手术。她的术后过程并无异常。由于新冠疫情期间的旅行和接触限制,她无法参加常规随访。她继续在新南威尔士州地区与当地医务人员进行复查。在首次手术6个月后,她因半胸骨切开术伤口底部有一处不愈合的病变,被转诊至当地医院的传染病诊所。计算机断层扫描显示深部胸骨伤口感染,感染已深入至骨骼。她入院接受治疗。鉴定出的主要病原体是多育卷霉——一种影响免疫抑制患者的危险真菌。强效抗真菌药和辅助抗生素对清除感染作用不大。需要进行根治性手术清创以获得清洁的组织边缘。