经支气管镜静脉-静脉体外膜肺氧合联合长时间两性霉素 B 灌注成功治疗气管支气管毛霉菌病：病例报告。

Tracheobronchial mucormycosis successfully treated with venous-venous extracorporeal membrane oxygenation combined with prolonged amphotericin B instillation by Bronchoscopy: a case report.

机构信息

Department of Intensive Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China.

Department of Pharmacy, Drum Tower Hospital Affiliated to Nanjing University School of Medicine, Nanjing, 210008, China.

出版信息

BMC Infect Dis. 2024 Nov 14;24(1):1303. doi: 10.1186/s12879-024-10215-4.

DOI:10.1186/s12879-024-10215-4

PMID:39543475

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11566427/

Abstract

BACKGROUND

Tracheobronchial mucormycosis is a fatal opportunistic infection that mainly causes airway stenosis and is difficult to manage clinically.

CASE PRESENTATION

We report a case of severe tracheal stenosis caused by tracheobronchial mucormycosis in a 37-year-old female with a history of hyperthyroidism. She developed agranulopenia after oral methimazole administration and subsequently experienced asthma with dyspnea. Bronchoscopy, sputum culture, colony mass spectrometry, and microscopic cotton orchid staining confirmed tracheobronchial mucormycosis. The patient received venous-venous extracorporeal membrane oxygenation (VV-ECMO) and prolonged intratracheal instillation of amphotericin B (AmBD), combined with amphotericin B liposome (L-AmB) and isavuconazole intravenous infusion, ultimately resulting in successful treatment.

CONCLUSION

VV-ECMO combined with prolonged intratracheal instillation of AmBD is an effective method for the treatment of tracheobronchial mucormycosis.

摘要

背景

气管支气管毛霉菌病是一种致命的机会性感染，主要导致气道狭窄，临床治疗困难。

病例介绍

我们报告了一例 37 岁女性因气管支气管毛霉菌病导致严重气管狭窄的病例，该患者有甲状腺功能亢进症病史。她在口服甲巯咪唑后出现粒细胞减少症，随后出现哮喘伴呼吸困难。支气管镜检查、痰培养、菌落质谱和显微镜下棉花兰染色均证实为气管支气管毛霉菌病。患者接受静脉-静脉体外膜氧合（VV-ECMO）和长时间气管内滴注两性霉素 B（AmBD），联合两性霉素 B 脂质体（L-AmB）和伊曲康唑静脉输注，最终成功治疗。