Dreizen S, Bodey G P, McCredie K B, Keating M J
Oral Surg Oral Med Oral Pathol. 1985 May;59(5):499-504. doi: 10.1016/0030-4220(85)90091-x.
The clinicopathologic characteristics of orofacial aspergillosis in thirteen hospitalized patients who developed the infection while receiving chemotherapy for acute leukemia are described. Clinically, the primary sites of infection, in decreasing order of frequency, were the paranasal sinuses, nasal cavity, mouth, and facial skin; the corresponding order for the secondary sites was orbit, nasal cavity, facial skin, and mouth. Pathologically, the fungal lesions in the nasal, oral and sinusoidal cavities were black, ulcerated, and escharotic due as a direct result of tissue destruction by the organism and an indirect result of thrombotic vascular infarction. The orbital lesions were deep red, granulomatous, and productive of proptosis and ectropion. Seven of the thirteen patients had concomitant pulmonary aspergillosis. The orofacial infections were not responsive to antifungal therapy in the absence of remission of the leukemia and restoration of depressed host defenses. In two patients who did achieve remission, the aspergillosis was controlled by the intravenous administration of amphotericin B.
本文描述了13例在接受急性白血病化疗期间发生感染的住院患者口腔面部曲霉菌病的临床病理特征。临床上，感染的主要部位按频率递减顺序为鼻窦、鼻腔、口腔和面部皮肤；次要部位的相应顺序为眼眶、鼻腔、面部皮肤和口腔。病理上，鼻腔、口腔和鼻窦腔内的真菌病变呈黑色、溃疡状且有焦痂形成，这是机体对组织破坏的直接结果以及血栓性血管梗死的间接结果。眼眶病变为深红色、肉芽肿性，可导致眼球突出和睑外翻。13例患者中有7例同时患有肺曲霉菌病。在白血病未缓解且宿主防御功能未恢复的情况下，口腔面部感染对抗真菌治疗无反应。在2例确实实现缓解的患者中，通过静脉注射两性霉素B控制了曲霉菌病。
