Weng D E, Wilson W H, Little R, Walsh T J
Medicine Branch, National Cancer Institute, National Institute of Health, Bethesda, Maryland 20892, USA.
Clin Infect Dis. 1998 Mar;26(3):601-5. doi: 10.1086/514562.
We describe the medical management of isolated renal zygomycosis in an adult patient with AIDS during chemotherapy for AIDS-related lymphoma. After initial presentation during the first cycle of chemotherapy, the infection was contained within the kidney following recovery of the neutrophil count without medical or surgical intervention. Since he was not considered to be a candidate for nephrectomy, his infection was treated with amphotericin B lipid complex during subsequent chemotherapy. Neutropenia was minimized by the addition of cytokine support therapy with granulocyte colony-stimulating factor and reduced doses of chemotherapy. Following this strategy, his lymphoma completely resolved, and renal zygomycosis was controlled. At the time of this writing, he had been in complete remission for 18 months without evidence of progressive fungal infection. This report and our literature review indicate that isolated renal zygomycosis can be associated with a favorable prognosis, occurs with greatest frequency in patients with AIDS, is associated with parenteral access, and may be managed by medical therapy alone.
我们描述了一名成年艾滋病患者在接受艾滋病相关淋巴瘤化疗期间孤立性肾接合菌病的药物治疗情况。在化疗第一周期首次出现症状后，中性粒细胞计数恢复后，感染局限于肾脏，未进行药物或手术干预。由于他不被认为是肾切除术的候选者，在随后的化疗期间，其感染采用两性霉素B脂质体复合物治疗。通过添加粒细胞集落刺激因子的细胞因子支持疗法和减少化疗剂量，使中性粒细胞减少症降至最低。按照这一策略，他的淋巴瘤完全缓解，肾接合菌病得到控制。在撰写本文时，他已完全缓解18个月，无进行性真菌感染的迹象。本报告及我们的文献综述表明，孤立性肾接合菌病可能预后良好，在艾滋病患者中发生率最高，与肠外途径有关，且可能仅通过药物治疗即可控制。
