Zhao Tingting, Fang Yuan, Wu Qiuhui, Shi Minke, Ni Yueyan, Zou Ruyi, Liu Mengying, Wu Weiwei, Su Xin
Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, 210008, People's Republic of China.
Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, 210008, People's Republic of China.
Infect Drug Resist. 2025 Jul 25;18:3689-3694. doi: 10.2147/IDR.S530615. eCollection 2025.
To report a case of coinfection with mucormycosis and azole-resistant in a patient with poorly controlled type 2 diabetes, highlighting successfully treated with high-dose posaconazole combined with liposomal amphotericin B and lobectomy.
A 52-year-old man who presented to our hospital with a 1-month history of fever accompanied by productive cough and sputum. He had type 2 diabetes with poor control of glucose level. Chest computed tomography (CT) showed rapidly progressive multiple cavities and consolidation in the lungs. Sputum culture showed azole-resistant , confirmed by whole genome sequencing, which revealed mutations in non-azole target genes (eg, was wild-type). Targeted next-generation sequencing (tNGS) of bronchoalveolar lavage fluid (BALF) at admission detected and , while histopathology of right upper lobe necrotic material on day 18 confirmed mucormycosis. The patients had previously received intravenous voriconazole (400 mg/d) combined with inhaled amphotericin B (10 mg twice daily) for 2 weeks without improvement. Upon admission, initial treatment with isavuconazole, liposomal amphotericin B, and caspofungin was also ineffective. Subsequently, high-dose posaconazole (600 mg/d) combined with liposomal amphotericin B was administered.
Following the initiation of high-dose posaconazole and liposomal amphotericin B, the patient's temperature normalized, and pulmonary exudates significantly improved. Therapeutic drug monitoring (TDM) showed that posaconazole trough concentrations were maintained at 3-4 mg/L without significant hepatic or renal toxicity. The main adverse effects observed were hypokalemia and anorexia. After 102 days of antifungal therapy, the patient underwent successful lobectomy, leading to complete resolution of symptoms.
This case demonstrated the good efficacy and safety of high-dose posaconazole combined with liposomal amphotericin B in the treatment of azole-resistant and mucormycosis.
报告1例2型糖尿病控制不佳患者合并毛霉菌病和耐唑类感染的病例，强调采用大剂量泊沙康唑联合脂质体两性霉素B及肺叶切除术成功治疗。
一名52岁男性因发热伴咳痰1个月就诊于我院。他患有2型糖尿病，血糖控制不佳。胸部计算机断层扫描（CT）显示肺部有快速进展的多个空洞和实变。痰培养显示耐唑类，经全基因组测序证实，该测序揭示了非唑类靶基因中的突变（例如，为野生型）。入院时支气管肺泡灌洗液（BALF）的靶向二代测序（tNGS）检测到和，而第18天右上叶坏死物质的组织病理学证实为毛霉菌病。患者此前接受静脉注射伏立康唑（400mg/d）联合吸入两性霉素B（10mg，每日两次）治疗2周，病情无改善。入院后，使用艾沙康唑、脂质体两性霉素B和卡泊芬净进行初始治疗也无效。随后，给予大剂量泊沙康唑（600mg/d）联合脂质体两性霉素B。
开始使用大剂量泊沙康唑和脂质体两性霉素B后，患者体温恢复正常，肺部渗出明显改善。治疗药物监测（TDM）显示泊沙康唑谷浓度维持在3 - 4mg/L，无明显肝或肾毒性。观察到的主要不良反应为低钾血症和厌食。抗真菌治疗102天后，患者成功接受肺叶切除术，症状完全缓解。
该病例证明大剂量泊沙康唑联合脂质体两性霉素B治疗耐唑类感染和毛霉菌病具有良好的疗效和安全性。
