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病例报告:鼻脑型毛霉菌病与肺曲霉病合并存在,诊断颇具挑战性。

A case report: Comorbidity of Rhinocerebral mucormycosis and pulmonary aspergillosis with challenging diagnosis.

作者信息

Wang Qi, Huang YangYiYi, Ma HaiNa, Fan Guo-Kang

机构信息

Department of Otolaryngology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.

出版信息

Front Med (Lausanne). 2024 Sep 25;11:1398714. doi: 10.3389/fmed.2024.1398714. eCollection 2024.

Abstract

BACKGROUND

Mucormycosis is a rare opportunistic invasive fungal disease. Rhinocerebral mucormycosis (RCM) is clinically difficult to diagnose, and patients often die due to delayed diagnosis.

CASE DESCRIPTION

A patient with concurrent pulmonary aspergillosis was diagnosed with RCM caused by through metagenomic Next-Generation Sequencing (mNGS). Despite comprehensive treatment including surgery, amphotericin B, and posaconazole, the patient tragically passed away. The treatment was delayed due to repeated cultures of secretions were negative and pathological examination could not clarify which fungus is infected.

CONCLUSION

The clinical manifestations of RCM are not specific in the early stage, but the infection progresses rapidly. Therefore, early and accurate diagnosis is very important. mNGS is helpful for patients suspected of RCM, especially when conventional microbiology tests were negative.

摘要

背景

毛霉病是一种罕见的机会性侵袭性真菌病。鼻脑型毛霉病(RCM)在临床上难以诊断,患者常因诊断延误而死亡。

病例描述

一名同时患有肺曲霉病的患者通过宏基因组下一代测序(mNGS)被诊断为RCM。尽管接受了包括手术、两性霉素B和泊沙康唑在内的综合治疗,但患者不幸去世。由于分泌物反复培养阴性且病理检查无法明确感染的是哪种真菌,治疗被延误。

结论

RCM早期临床表现不具特异性,但感染进展迅速。因此,早期准确诊断非常重要。mNGS对疑似RCM的患者有帮助,尤其是在传统微生物学检测为阴性时。

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