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胫骨毛霉病:一例未解决实体的病例报告。

Mucor mycosis of tibia: A case report of An unsolved entity.

作者信息

Tomar Lavindra, Govil Gaurav

机构信息

Max Super Specialty Hospital, Patparganj, Delhi, India.

出版信息

J Clin Orthop Trauma. 2024 Oct 29;58:102793. doi: 10.1016/j.jcot.2024.102793. eCollection 2024 Nov.

Abstract

Mucormycosis of tibia is a highly aggressive fungal infection. It is an uncommon affection especially in immunocompromised host who have more propensity for such affections. The nonhealing ulcer of the left leg in an immunocompromised host status of a 45-year-old male presented with a radiological lytic lesion of the distal lower fourth of tibia. The initial biopsy confirmed tubercular affection which responded to antitubercular medications to allow radiological healing. However, the repeat biopsy showed Mucormycosis which remained recalcitrant to antifungal medications with unresponsive wound healing and persisting suppuration. The case presented unique scenario of superadded fungal infection in a healing tubercular osteomyelitis tibia with alcoholic liver disease compromised host immunity. The fungal infection of tibia remains an unsolved entity with poor clinical and functional outcomes. An early detection, high degree of suspicion with an adequate dosage of antifungal medications may allow resolution of the dreaded infection though an effective treatment remains an unsolved entity.

摘要

胫骨毛霉病是一种极具侵袭性的真菌感染。它是一种罕见的病症,尤其在免疫功能低下的宿主中更为常见,这类宿主更容易感染此类疾病。一名45岁男性处于免疫功能低下状态,左腿出现不愈合溃疡,胫骨远端下四分之一处有放射学上的溶骨性病变。最初的活检证实为结核感染,对抗结核药物有反应,放射学上实现了愈合。然而,再次活检显示为毛霉病,对抗真菌药物无反应,伤口愈合不良且持续化脓。该病例呈现出一种独特的情况,即愈合中的胫骨结核性骨髓炎合并酒精性肝病导致宿主免疫功能受损,在此基础上又叠加了真菌感染。胫骨真菌感染仍然是一个尚未解决的问题,临床和功能预后较差。早期检测、高度怀疑并给予足够剂量的抗真菌药物可能有助于解决这种可怕的感染,尽管有效的治疗仍然是一个未解决的问题。

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