Bilal Hazrat, Li Xiaohui, Lv Qiao-Li, Qiu Hanman, Qiu Yu-An, Xu Bin
Jiangxi Key Laboratory of Oncology (2024SSY06041), JXHC Key Laboratory of Tumour Metastasis, NHC Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma, Jiangxi Cancer Hospital & Institute, The Second Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, 330029, People's Republic of China.
Department of Critical Care Medicine Jiangxi Cancer Hospital & Institute, The Second Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, 330029, People's Republic of China.
Infect Drug Resist. 2025 Jul 4;18:3281-3287. doi: 10.2147/IDR.S526660. eCollection 2025.
Invasive mucormycosis is a severe fungal infection that predominantly affects immunocompromised and diabetic patients. This case study highlights the importance of early diagnosis and pathogen-specific antifungal therapy in managing invasive mucormycosis among high-risk patients.
A 47-year-old male with chronic lymphocytic leukemia (Rai stage IV) on zanubrutinib and with uncontrolled diabetes was admitted to Jiangxi Cancer Hospital on November 7, 2021. Imaging revealed pulmonary infection and splenic infarction, while laboratory findings suggested disseminated intravascular coagulation. Despite empirical broad-spectrum antibiotics, his condition worsened, necessitating an emergency splenectomy. Postoperatively, fluconazole was added to his antimicrobial regimen, but he developed respiratory failure, liver and renal dysfunction, and persistent hyperglycemia. A bronchial alveolar lavage sample was sent for metagenomic next-generation sequencing (mNGS) to identify the pathogen. Despite intensive care, he deteriorated rapidly, developing myocardial injury, metabolic acidosis, and multiorgan failure, leading to death on November 13, 2021. mNGS results, received after the patient's death, identified as the primary pathogen, with co-infection by and .
This study presents a case of rapidly progressive mucormycosis co-infected with bacterial and viral pathogens, highlighting the importance of early intervention and accurate diagnosis. Delayed identification of the fungal pathogen significantly hindered timely antifungal intervention, underscoring the importance of appropriate empirical therapies in hematological patients treated with zanubrutinib. Future research should focus on antifungal stewardship and epidemiological surveillance studies to improve early detection and guide targeted empirical treatment for high-risk populations.
侵袭性毛霉病是一种严重的真菌感染，主要影响免疫功能低下和糖尿病患者。本病例研究强调了早期诊断和针对病原体的抗真菌治疗在管理高危患者侵袭性毛霉病中的重要性。
一名47岁男性，患有慢性淋巴细胞白血病（Rai分期IV期），正在接受泽布替尼治疗且患有未得到控制的糖尿病，于2021年11月7日入住江西省肿瘤医院。影像学检查显示肺部感染和脾梗死，而实验室检查结果提示弥散性血管内凝血。尽管使用了经验性广谱抗生素，但其病情仍恶化，需要进行紧急脾切除术。术后，在其抗菌治疗方案中添加了氟康唑，但他出现了呼吸衰竭、肝肾功能障碍和持续高血糖。一份支气管肺泡灌洗样本被送去进行宏基因组下一代测序（mNGS）以鉴定病原体。尽管进行了重症监护，他的病情迅速恶化，出现心肌损伤、代谢性酸中毒和多器官功能衰竭，于2021年11月13日死亡。在患者死亡后获得的mNGS结果显示， 为主要病原体，并合并有 和 的感染。
本研究呈现了一例合并细菌和病毒病原体感染的快速进展性毛霉病病例，强调了早期干预和准确诊断的重要性。真菌病原体的延迟鉴定严重阻碍了及时的抗真菌干预，突出了在接受泽布替尼治疗的血液病患者中进行适当经验性治疗的重要性。未来的研究应侧重于抗真菌管理和流行病学监测研究，以改善早期检测并指导针对高危人群的靶向经验性治疗。
