Hsu C F, Wang C C, Hung C S, Cheng S N, Chen Y H, Chu M L
Department of Pediatrics, National Defense Medical Center, Taipei, Taiwan, R.O.C.
Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1998 May-Jun;39(3):191-4.
A 23-month-old boy, a victim of acute myelomonocytic leukemia (AML), was admitted for chemotherapy. On the eighth hospital day, he started a one-week course of chemotherapy with agents of epirubicin and cytosine arabinoside. Unfortunately, persistent neutropenia, deteriorating diarrhea and intermittently spiking fever developed from the sixteenth hospital day. Initially, ceftazidime and amikacin were empirically utilized. Blood culture yielded Klebsiella pneumoniae and the fever subsided for one day. Unfortunately, oral mucositis and catheter-induced phlebitis developed subsequently. Subsequently, oral nystatin and intravenous oxacillin were added. The results of cultures from both blood and oral mucosal tissue yielded a fungus. Trichosporon beigelii. We changed from an oral antifungal agent to intravenous amphotericin B on the twenty-fourth hospital day. He presented signs of septic shock with disseminated intravascular coagulopathy and expired on the twenty-fifth hospital day after failure to respond to aggressive resuscitation. We report this case to emphasize that in cytotoxic chemotherapy-induced granulocytopenic AML patients who have compromised immune systems, and who may manifest some signs or symptoms of infection, and at the same time poorly respond to interventional antibiotic treatment, the possibility of T. beigelii infection can not be neglected.
一名23个月大的男孩，患有急性粒单核细胞白血病（AML），因化疗入院。住院第8天，他开始接受为期一周的化疗，使用表柔比星和阿糖胞苷。不幸的是，从住院第16天起出现持续中性粒细胞减少、腹泻加重和间歇性高热。起初，经验性地使用了头孢他啶和阿米卡星。血培养检出肺炎克雷伯菌，发热消退一天。不幸的是，随后出现了口腔黏膜炎和导管相关性静脉炎。随后，加用了口服制霉菌素和静脉注射苯唑西林。血液和口腔黏膜组织培养结果均检出一种真菌，白吉利丝孢酵母。住院第24天，我们将口服抗真菌药改为静脉注射两性霉素B。他出现了感染性休克伴弥散性血管内凝血的症状，在积极复苏无效后于住院第25天死亡。我们报告此病例以强调，在细胞毒性化疗引起粒细胞减少的AML患者中，这些患者免疫系统受损，可能出现一些感染的体征或症状，同时对抗感染治疗反应不佳时，不能忽视白吉利丝孢酵母感染的可能性。
