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糖尿病患者鼻眶毛霉菌病的成功治疗:一例报告

Successful Management of Rhino-Orbital Mucormycosis in a Diabetic Patient: A Case Report.

作者信息

Tsisar Stanislav, Salvado de Morais Mariana, Gameiro Rita, Rodrigues Mario

机构信息

Internal Medicine, Centro Hospitalar Universitário Lisboa Central - Hospital de São José, Lisbon, PRT.

出版信息

Cureus. 2025 Jan 1;17(1):e76739. doi: 10.7759/cureus.76739. eCollection 2025 Jan.

Abstract

Mucormycosis is a rare but aggressive fungal infection, primarily affecting immunocompromised patients, with diabetes being a significant risk factor. This report describes the case of a 20-year-old male with poorly controlled type 1 diabetes who presented with facial swelling, proptosis, and necrotic nasal lesions. Imaging and biopsy confirmed rhino-orbital mucormycosis with . The patient underwent multiple surgical debridements and received dual antifungal therapy with liposomal amphotericin B and isavuconazole, alongside adjunctive hyperbaric oxygen therapy. Despite multiple complications, such as septic and cardiogenic shock, "in and out" diabetic ketoacidosis, and long-term oral compromise, clinical stabilization was achieved after prolonged hospitalization and a multidisciplinary approach. Currently, the patient is clinically and radiologically stable over two years of suppressive therapy with isavuconazole. This case highlights the importance of early diagnosis, aggressive multidisciplinary management, and tailored antifungal therapy in the treatment of rhino-orbital mucormycosis.

摘要

毛霉菌病是一种罕见但侵袭性的真菌感染,主要影响免疫功能低下的患者,糖尿病是一个重要的危险因素。本报告描述了一名1型糖尿病控制不佳的20岁男性患者,其表现为面部肿胀、眼球突出和鼻坏死性病变。影像学检查和活检确诊为鼻眶毛霉菌病。患者接受了多次手术清创,并接受了脂质体两性霉素B和艾沙康唑的双重抗真菌治疗,同时辅以高压氧治疗。尽管出现了多种并发症,如感染性和心源性休克、“反复”的糖尿病酮症酸中毒以及长期的口腔功能障碍,但经过长时间住院和多学科治疗后,患者实现了临床稳定。目前,在接受艾沙康唑抑制治疗两年后,患者在临床和影像学上均保持稳定。该病例突出了早期诊断、积极的多学科管理以及针对性抗真菌治疗在鼻眶毛霉菌病治疗中的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/618a/11784923/aaccccf2d5eb/cureus-0017-00000076739-i01.jpg

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