Webb M, Dowdy L, Bundschu C, Nery J, Schiff E, Tzakis A G
Department of Surgery, University of Miami School of Medicine, Florida, USA.
Clin Transplant. 1998 Dec;12(6):596-9.
A fatal case of cerebral mucormycosis occurring shortly after liver transplantation is described. The patient was a 32-yr-old male with advanced end-stage liver disease manifested by tense ascites, spontaneous bacterial peritonitis, deepening jaundice and anuria requiring hemodialysis. The 3rd day after successful liver transplantation the patient developed acute respiratory failure, then focal motor signs. Computed tomography showed fluid in the left maxillary sinus, partial opacification of the ethmoid and sphenoid sinuses, and diffuse low density lesions in both cerebral hemispheres. Despite treatment for cerebritis and cerebral edema, the patient's pupils became fixed and dilated, and brain death was declared. Autopsy revealed mucor sinusitis and cerebritis. Mucormycosis is an opportunistic fungal infection occurring in patients with diabetic ketoacidosis, malignancy, or immunodeficiency, and in those receiving wide-spectrum antibiotics, corticosteroids, or cytotoxic therapy. Mucor most frequently involves the face, rhinocerebral disease predominating. These infections are difficult to treat, but are curable with aggressive and frequent surgical debridement, discontinuation or reduction of immunosuppressive therapy and amphotericin. The diagnosis of mucormycosis is very difficult to make in cases such as the present one, in which the typical presentation and classical signs are not present. A high index of suspicion based on identified risk factors may assist in more rapid diagnosis of this life-threatening mycosis.
本文描述了一例肝移植后不久发生的致命性脑毛霉菌病病例。患者为一名32岁男性，患有晚期终末期肝病，表现为严重腹水、自发性细菌性腹膜炎、黄疸加深及无尿，需进行血液透析。肝移植成功后第3天，患者出现急性呼吸衰竭，随后出现局灶性运动体征。计算机断层扫描显示左侧上颌窦有积液，筛窦和蝶窦部分混浊，双侧大脑半球有弥漫性低密度病变。尽管对脑炎和脑水肿进行了治疗，但患者瞳孔固定散大，最终宣布脑死亡。尸检发现毛霉菌性鼻窦炎和脑炎。毛霉菌病是一种机会性真菌感染，发生于糖尿病酮症酸中毒、恶性肿瘤或免疫缺陷患者，以及接受广谱抗生素、皮质类固醇或细胞毒性治疗的患者。毛霉菌最常累及面部，以鼻脑疾病为主。这些感染难以治疗，但通过积极频繁的手术清创、停用或减少免疫抑制治疗以及使用两性霉素可治愈。在本例这种没有典型表现和经典体征的病例中，毛霉菌病的诊断非常困难。基于已确定的危险因素保持高度怀疑指数可能有助于更快诊断这种危及生命的霉菌病。
