异基因造血干细胞移植后茄病镰刀菌感染一例并文献复习  

Fusarium solani infection in a patient after allogeneic hemotopoietic stem cell transplantation： case report and literature review

作　　者：扈江伟[1] 舒向荣[1] 任婧[1] 尹秀云[2] 江岷[1] 胡亮钉[1] 张波[3] 陈虎[1] 

机构地区：[1]军事医学科学院附属医院造血干细胞移植中心,北京100071 [2]军事医学科学院附属医院细菌室,北京100071 [3]空军总医院呼吸科

出　　处：《中华结核和呼吸杂志》2010年第10期730-733,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的 提高对免疫低下患者茄病镰刀菌感染的认识,探讨治疗方案.方法 报道1例急性髓性白血病异基因造血干细胞移植后合并茄病镰刀菌感染患者的临床表现、治疗经过和转归并进行文献复习.结果 患者男,46岁,于干细胞移植术后出现肺部浸润影及全身多发性皮下包块,组织涂片见大量菌丝及孢子,真菌培养为茄病镰刀菌,行皮下包块切开引流,两性霉素B及伏立康唑抗真菌治疗,恢复后痊愈出院.以＂造血干细胞移植＂或＂异基因造血干细胞移植＂或＂骨髓移植＂＋＂茄病镰刀菌＂为关键词在Medline和中国生物医学文献光盘数据库中进行检索,未发现中文报道,国外文献报道7篇,共8例,其中男5例,女3例,主要临床表现为发热及全身皮肤损害,预后极差,8例中7例死亡,1例治愈.结论 茄病镰刀菌感染是造血干细胞移植后少见的、致死性的并发症,应引起足够重视,对异常皮肤损害或皮下包块应尽快行组织涂片及培养,早期明确诊断并给予足量抗真菌治疗.Objective To study Fusarium solani infection as a complication in patients after allogeneic hemotopoietic stem cell transplantation and to discuss the diagnosis and appropriate therapy.Methods Symptoms, physical examination, laboratory tests, computed tomographic （CT） scans, treatments and outcomes of Fusarium solani infection in a patient with acute myeloid leukemia after allogeneic hemotopoietic stem cell transplantation were retrospectively analyzed, and related literatures reviewed.Results The patient developed pulmonary infiltration and systemic multiple subcutaneous masses after allogeneic hemotopoietic stem cell transplantation. Tissue biopsy smear showed a large number of hyphae and spores, and fungal culture grew Fusarium solani. The subcutaneous masses were incised and drained, while amphotericin B and voriconazole were administered, with granulocyte colony-stimulating factor（G-CSF） and granulocyte-macrophage colony-stimulating factor （GM-CSF）for hematopoietic recovery. The patient was discharge after full recovery. Conclusion Fusarium solani infection is a rare but fatal complication after allogeneic hemotopoietic stem cell transplantation. Once the skin lesions or subcutaneous masses developed,tissue smear and culture should be done as soon as possible. Early diagnosis and effective treatment to recovery of the patient after allogeneic hemotopoietic stem cell transplant. Moreover,the recovery of adequate neutrophil levels is the most important factor in the resolution of fusarial infection.

关 键 词：造血干细胞移植 镰刀菌属 皮肤真菌病 

分 类 号：R686[医药卫生—骨科学]