Hinterberger W, Fridrich L, Graninger W, Kleinberger G, Lechner K, Neumann E, Schwarzmeier J, Radaskiewicz T, Deutsch E
Acta Haematol. 1982;67(2):94-101. doi: 10.1159/000207033.
A 17-year-old male patient with aplastic anemia underwent bone marrow transplantation and succumbed 4 days after marrow infusion from sudden myocardial failure. Fever of unknown origin (FUO) had accompanied the patients course from admission until death. The cause of death was fungus myocarditis, which had escaped detection in vivo, in spite of a daily culture program for bacteria and fungi, and a close monitoring of the patients circulation and ventricular performance. Commonly applied diagnostic criteria for systemic mycosis, such as topical colonization, malfunction of invaded organs and positive fungus cultures failed to provide a timely diagnosis. With regard to the problems in diagnosing systemic mycosis, the potential stem cell toxicity of antifungal drugs and the need for immunosuppressive therapy prior to marrow infusion, we strongly recommend not to start the transplantation procedure unless FUO has been treated successfully.
一名17岁再生障碍性贫血男性患者接受了骨髓移植，在骨髓输注4天后因突发性心肌衰竭死亡。从入院到死亡，患者病程中一直伴有不明原因发热（FUO）。死亡原因是真菌性心肌炎，尽管每天进行细菌和真菌培养，并密切监测患者的循环和心室功能，但在体内仍未被发现。常用的系统性真菌病诊断标准，如局部定植、受侵器官功能障碍和真菌培养阳性，均未能及时作出诊断。鉴于系统性真菌病诊断存在问题、抗真菌药物对干细胞的潜在毒性以及骨髓输注前需要进行免疫抑制治疗，我们强烈建议在不明原因发热未成功治疗之前不要开始移植程序。
