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成功治疗类固醇诱导免疫功能低下患者合并额骨侵犯的鼻脑毛霉菌病

Successful Management of Rhinocerebral Mucormycosis With Frontal Bone Invasion in a Steroid-Induced Immunocompromised Patient.

作者信息

Kim Jong Seung, Chae Gwang Min, Shin Jin Yong

机构信息

Department of Otorhinolaryngology-Head and Neck Surgery, Medical School of Jeonbuk National University.

Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital.

出版信息

J Craniofac Surg. 2025 Sep 17. doi: 10.1097/SCS.0000000000011867.

Abstract

Rhinocerebral mucormycosis is a rare but life-threatening fungal infection that progresses rapidly, particularly in immunocompromised patients. The authors report a case of a 65-year-old female with no prior history of diabetes or malignancy who developed invasive mucormycosis following corticosteroid treatment for immune thrombocytopenia. The infection extended from the nasal cavity through the cribriform plate into the frontal bone and dura mater. Initial endoscopic debridement with nasoseptal flap reconstruction was followed by a second-stage bicoronal resection and titanium plate reconstruction due to progressive bony invasion. Histopathology confirmed mucormycosis with angioinvasive hyphae. The patient was successfully treated with staged surgery and systemic liposomal amphotericin B, showing full recovery without recurrence at 6 months. This case highlights the importance of early recognition, aggressive surgical management, and multidisciplinary care in immunocompromised patients with atypical presentations of mucormycosis.

摘要

鼻脑型毛霉菌病是一种罕见但危及生命的真菌感染,进展迅速,尤其在免疫功能低下的患者中。作者报告了一例65岁女性病例,该患者既往无糖尿病或恶性肿瘤病史,在接受免疫性血小板减少症的皮质类固醇治疗后发生侵袭性毛霉菌病。感染从鼻腔经筛板蔓延至额骨和硬脑膜。最初进行了鼻内镜清创术并采用鼻中隔瓣重建,随后由于骨质侵袭进展而进行了二期双冠状切除术和钛板重建。组织病理学证实为毛霉菌病,伴有血管侵袭性菌丝。该患者通过分期手术和全身性脂质体两性霉素B成功治疗,6个月时完全康复且无复发。该病例强调了在免疫功能低下且表现不典型的毛霉菌病患者中早期识别、积极手术治疗和多学科护理的重要性。

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