Zhang Zhengyang, Wang Min
Shandong University of Traditional Chinese Medicine, Jinan, China.
The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.
Front Med (Lausanne). 2025 Jul 9;12:1580912. doi: 10.3389/fmed.2025.1580912. eCollection 2025.
Pulmonary mucormycosis (PM) is an invasive and life-threatening fungal infection that predominantly affects immunocompromised individuals. This study thoroughly examined the disease through three case reports and a literature review. Case 1 involved a patient with type 1 diabetes mellitus diagnosed through bronchoscopic histopathology, who succumbed despite a combination of oral isavuconazole, nebulized amphotericin B, and intravenous amphotericin B cholesteryl sulfate complex. Case 2 involved a patient with follicular non-Hodgkin lymphoma who had a concurrent coronavirus disease 2019 (COVID-19) infection, which was confirmed through metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF). The patient experienced clinical improvement following sequential intravenous voriconazole, amphotericin B cholesteryl sulfate complex, and oral isavuconazole. Case 3 involved a patient diagnosed with mNGS in a lung cancer patient with chronic obstructive pulmonary disease, who showed poor therapeutic response to combined intravenous voriconazole, amphotericin B cholesteryl sulfate complex, and oral isavuconazole, resulting in fatal outcomes. Literature synthesis revealed mortality rates of 28.3% with antifungal monotherapy compared to 23.7% when antifungal monotherapy was combined with bronchoscopic intervention; the mortality rate for antifungal-surgical combination therapy was 9%. Notably, all 13 patients receiving multimodal treatment (antifungals, bronchoscopy, and surgery) survived. These findings underscore that combination therapy integrating pharmacotherapy, bronchoscopic intervention, and surgical resection demonstrated significantly superior survival outcomes compared to monotherapy.
肺毛霉病（PM）是一种侵袭性且危及生命的真菌感染，主要影响免疫功能低下的个体。本研究通过三例病例报告和文献综述对该疾病进行了全面检查。病例1涉及一名通过支气管镜组织病理学诊断为1型糖尿病的患者，尽管联合使用了口服艾沙康唑、雾化两性霉素B和静脉注射两性霉素B胆固醇硫酸酯复合物，但仍死亡。病例2涉及一名滤泡性非霍奇金淋巴瘤患者，其同时感染了2019冠状病毒病（COVID-19），这通过支气管肺泡灌洗（BALF）的宏基因组下一代测序（mNGS）得到证实。该患者在先后静脉注射伏立康唑、两性霉素B胆固醇硫酸酯复合物和口服艾沙康唑后病情出现临床改善。病例3涉及一名患有慢性阻塞性肺疾病的肺癌患者，通过mNGS诊断，该患者对静脉注射伏立康唑、两性霉素B胆固醇硫酸酯复合物和口服艾沙康唑联合治疗反应不佳，导致死亡。文献综合分析显示，抗真菌单药治疗的死亡率为28.3%，而抗真菌单药治疗联合支气管镜干预时为23.7%；抗真菌-手术联合治疗的死亡率为9%。值得注意的是，所有接受多模式治疗（抗真菌药物、支气管镜检查和手术）的13名患者均存活。这些发现强调，与单药治疗相比，整合药物治疗、支气管镜干预和手术切除的联合治疗显示出显著更好的生存结果。
