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一名糖尿病控制不佳患者的肺结核与毛霉病合并感染:病例报告

Coinfection of pulmonary tuberculosis and mucormycosis in a patient with poor controlled diabetes mellitus: A case report.

作者信息

Shahanikelaki Mehran, Mohammadi Mohammad, Mohammadi Aynaz, Moradians Vahan

机构信息

Department of Internal Medicine, School of Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran.

School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

出版信息

Radiol Case Rep. 2023 Sep 18;18(11):4202-4205. doi: 10.1016/j.radcr.2023.08.091. eCollection 2023 Nov.

Abstract

Coinfection of pulmonary mucormycosis and tuberculosis is a rare and challenging condition, particularly in immunocompromised patients. We present the case of a 60-year-old woman with poorly controlled diabetes mellitus who developed dysphonia, persistent cough, and expectoration. Imaging studies revealed a cavitary lesion and a mass in the left lung, along with stenosis of the left main bronchus. A bronchoscopy confirmed the presence of a bronchomediastinal fistula with pus discharge. Polymerase chain reaction testing of bronchial secretions revealed a co-infection of tuberculosis and mucormycosis. The patient was initiated on appropriate treatment for both infections, and her symptoms improved without disease progression. Concomitant pulmonary mucormycosis and tuberculosis pose significant diagnostic challenges due to overlapping clinical and radiological features. Early recognition and a multidisciplinary approach involving infectious disease specialists, pulmonologists, radiologists, and surgeons are crucial for optimal management. The prognosis of this coinfection is poor, emphasizing the importance of timely diagnosis and treatment. To improve outcomes, comprehensive screening and early detection of coinfections in high-risk patients, such as those with uncontrolled diabetes, are essential. Future advancements in diagnostic tools may facilitate prompt and accurate diagnosis. Clinicians should maintain a high index of suspicion and employ appropriate diagnostic techniques to ensure early identification and effective management of these complex infections.

摘要

肺毛霉病和肺结核合并感染是一种罕见且具有挑战性的病症,尤其是在免疫功能低下的患者中。我们报告了一例60岁糖尿病控制不佳的女性病例,该患者出现了声音嘶哑、持续性咳嗽和咳痰症状。影像学检查显示左肺有空洞性病变和肿块,同时左主支气管狭窄。支气管镜检查证实存在伴有脓性分泌物的支气管纵隔瘘。支气管分泌物的聚合酶链反应检测显示结核和毛霉病合并感染。该患者开始接受针对两种感染的适当治疗,其症状得到改善且病情未进展。由于临床和影像学特征重叠,同时存在的肺毛霉病和肺结核构成了重大的诊断挑战。早期识别以及由传染病专家、肺科医生、放射科医生和外科医生组成的多学科方法对于优化管理至关重要。这种合并感染的预后较差,凸显了及时诊断和治疗的重要性。为改善预后,对高危患者(如糖尿病控制不佳者)进行全面筛查和早期发现合并感染至关重要。诊断工具的未来进展可能有助于迅速而准确的诊断。临床医生应保持高度的怀疑指数并采用适当的诊断技术,以确保早期识别和有效管理这些复杂感染。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3f62/10518342/c0cecfca9ea2/gr1.jpg

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