Zhao Yuxi, Wu Xiaoxin, Wang Xinyu, Li Lanjuan
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou City, 310003, China.
BMC Infect Dis. 2025 Jan 24;25(1):116. doi: 10.1186/s12879-025-10503-7.
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease characterized by leukopenia and thrombocytopenia, and aspergillosis is a common complication in severe cases. Previous studies have reported cases of SFTS complicated with invasive pulmonary aspergillosis (IPA) and central nervous system aspergillosis. Here, we present the first case of an immunocompetent patient with SFTS who progressed to IPA and Aspergillus endocarditis after glucocorticoid treatment, and embolism of the vegetations from the left ventricle led to multiple infarctions in the brain, kidney, and spleen.
A 66-year-old male farmer developed altered mental status during SFTS. His consciousness improved during the treatment of glucocorticoids, intravenous immunoglobulin, and ribavirin, but he developed embolisms in the spleen and right kidney, initially attributed to atrial fibrillation, and the anticoagulant agent was not administered due to the high risk of bleeding. Later, He was diagnosed with SFTS-associated IPA (SAPA), for which voriconazole was administered. However, he subsequently experienced a recurrence of altered mental status, accompanied by headache, blindness, and muscle weakness. Brain magnetic resonance imaging (MRI) revealed multiple cerebral embolisms and abscess. The echocardiography showed the vegetations in the left ventricle, suggesting multi-organ embolism caused by infective endocarditis (IE). Aspergillus fumigatus was confirmed through pathology and culture of the excised vegetations. The patient was eventually discharged with improved consciousness and muscle strength, but his vision showed minimal recovery.
Clinicians should be wary of aspergillosis in severe patients with SFTS, particularly those receiving glucocorticoid treatment. In patients with SAPA, cerebral aspergillosis and embolic stroke caused by Aspergillus endocarditis should also be considered when mental status alters. Furthermore, the possibility of Aspergillosis in other organs should be considered in high-risk patients.
发热伴血小板减少综合征（SFTS）是一种以白细胞减少和血小板减少为特征的新发传染病，曲霉病是重症患者的常见并发症。既往研究报道过SFTS合并侵袭性肺曲霉病（IPA）和中枢神经系统曲霉病的病例。在此，我们报告首例免疫功能正常的SFTS患者，在接受糖皮质激素治疗后进展为IPA和曲霉性心内膜炎，左心室赘生物栓塞导致脑、肾和脾多发梗死。
一名66岁男性农民在患SFTS期间出现精神状态改变。在接受糖皮质激素、静脉注射免疫球蛋白和利巴韦林治疗期间，他的意识有所改善，但随后出现脾脏和右肾栓塞，最初归因于心房颤动，由于出血风险高未给予抗凝剂。后来，他被诊断为SFTS相关的IPA（SAPA），并接受伏立康唑治疗。然而，他随后再次出现精神状态改变，伴有头痛、失明和肌肉无力。脑部磁共振成像（MRI）显示多发脑栓塞和脓肿。超声心动图显示左心室有赘生物，提示感染性心内膜炎（IE）导致多器官栓塞。通过切除赘生物的病理检查和培养确诊为烟曲霉。患者最终出院时意识和肌肉力量有所改善，但视力恢复甚微。
临床医生应警惕重症SFTS患者发生曲霉病，尤其是接受糖皮质激素治疗的患者。对于SAPA患者，当精神状态改变时，还应考虑脑曲霉病和曲霉性心内膜炎引起的栓塞性中风。此外，高危患者应考虑其他器官发生曲霉病的可能性。
