Jia Zhenlei, Qian Yujie, Zhang Lili, Li Yun, Chen Zhiguo, Zhao Ling, Du Juan, Tuo Guangxin, Yue Fang
Department of Thoracic Surgery, Hebei Provincial Children's Hospital, Shijiazhuang, China.
Department of Pathology, Hebei Provincial Children's Hospital, Shijiazhuang, China.
Front Pediatr. 2025 Jun 10;13:1591953. doi: 10.3389/fped.2025.1591953. eCollection 2025.
Mucormycosis, a severe disease caused by fungal infections of the Mucorales order, is a frequent cause of mortality in patients with hematological malignancies. Pulmonary mucormycosis represents a common form of this condition in pediatric patients with hematological malignancies and is associated with a high mortality rate. Liposomal amphotericin B (L-AmB) remains the primary therapeutic agent for pulmonary mucormycosis, however, its efficacy is often limited. We report a case of treating pulmonary mucormycosis in a pediatric patient with acute lymphoblastic leukemia (ALL) using fiberoptic bronchoscopy (FB) combined with thoracoscopic surgery, in conjunction with antifungal therapy including L-AmB.
A 3-year-old male patient with a 1-year history of ALL. After the 11th chemotherapy session, the patient developed symptoms including fever, cough, and sputum production. Comprehensive diagnostic evaluations confirmed the presence of pulmonary mucormycosis in the right lung. On the basis of adequate administration of multiple antifungal agents, we conducted two fiberoptic bronchoscopy-guided bronchoalveolar lavage procedures for the child, successfully confining the lesion to the right upper lobe. However, the child continued to experience intermittent hemoptysis. Subsequently, we performed a thoracoscopic right upper lobectomy for the child. The child was discharged smoothly 9 days after the operation, and the postoperative pathology also indicated a fungal infection. One month postoperatively, a follow-up chest CT scan revealed no significant infection in either lung. Chemotherapy for ALL was continued. The child was followed up for three years after completion of treatment and remained in good health with no notable symptoms.
The treatment of childhood ALL complicated with pulmonary mucormycosis is particularly challenging and associated with a high mortality rate. For children with severe infections, combining antifungal therapy, such as L-AmB, with bronchoscopy and thoracoscopic surgery has been shown to be both feasible and effective.
毛霉病是由毛霉目真菌感染引起的一种严重疾病，是血液系统恶性肿瘤患者死亡的常见原因。肺毛霉病是血液系统恶性肿瘤儿科患者中这种疾病的常见形式，且死亡率很高。脂质体两性霉素B（L-AmB）仍然是肺毛霉病的主要治疗药物，然而，其疗效往往有限。我们报告了一例使用纤维支气管镜（FB）联合胸腔镜手术治疗急性淋巴细胞白血病（ALL）儿科患者肺毛霉病的病例，并结合包括L-AmB在内的抗真菌治疗。
一名3岁男性患者，有1年ALL病史。在第11次化疗疗程后，患者出现发热、咳嗽和咳痰等症状。综合诊断评估证实右肺存在肺毛霉病。在充分给予多种抗真菌药物的基础上，我们为患儿进行了两次纤维支气管镜引导下的支气管肺泡灌洗术，成功将病变局限于右上叶。然而，患儿仍间歇性咯血。随后，我们为患儿进行了胸腔镜右上叶切除术。患儿术后9天顺利出院，术后病理也显示为真菌感染。术后1个月，胸部CT随访扫描显示双肺均无明显感染。继续进行ALL化疗。治疗完成后对患儿进行了三年随访，患儿身体健康，无明显症状。
儿童ALL合并肺毛霉病的治疗极具挑战性，死亡率很高。对于严重感染的儿童，将抗真菌治疗（如L-AmB）与支气管镜检查和胸腔镜手术相结合已被证明是可行且有效的。
