儿童白血病化疗后合并肺毛霉菌病1例报告并文献复习  

Pulmonary mucormycosis after chemotherapy in children with leukemia: a case report and literature review

作　　者：陈莹莹[1] 郑浩[1] 陈彩[1] 郑湧智 阮琰 李健[1] CHEN Yingying;ZHENG Hao;CHEN Cai;ZHENG Yongzhi;RUAN Yan;LI Jian(Department of Pediatric Hematology,FujianMedical University Union Hospital,Fujian Provincial Key Laboratory,Fujian Medical University Union Hospital,Fuzhou350001,Fujian,China;Department of Pediatric,Fuzhou Pulmonary Hospital of Fujian,Fuzhou 350001,Fujian,China)

机构地区：[1]福建医科大学附属协和医院小儿血液科福建省血液病研究所福建省血液病学重点实验室 [2]福建省福州肺科医院儿科,福建福州350001

出　　处：《临床儿科杂志》2019年第10期769-773,共5页Journal of Clinical Pediatrics

基　　金：福建省临床重点专科建设项目[No.闽政办（2017）4号];福建省临床重点专科建设项目[No.闽卫科教（2012）149号];国家临床重点专科建设项目[No.闽财指（2011）1006号]

摘　　要：目的提高对儿童白血病化疗后合并肺毛霉菌感染的认识。方法回顾分析1例急性B淋巴细胞性白血病(B-ALL)患儿诱导化疗后合并肺毛霉菌病的临床资料,并复习相关文献。结果2岁女童,确诊B-ALL,诱导化疗后骨髓抑制期合并肺部感染、脓气胸,临床表现为胸痛、咯血,肺部CT提示右下肺实变,多次痰及胸水培养阴性。气胸第22天胸水行感染病原高通量测序发现毛霉菌,随后经纤维支气管镜活检病理证实病原学诊断。予两性霉素B脂质体静滴、普通两性霉素B雾化吸入治疗。第55天拔除胸腔引流管,并序贯口服泊沙康唑。治疗2月余后复查肺部CT提示右下肺实变病灶缩小;纤维支气管镜下见右中间段支气管干肉芽增生。遂行镜下氩气刀清理。之后序贯口服泊沙康唑,并继续按白血病化疗方案治疗。10个月后复查肺部病灶较前明显吸收。结论肺毛霉菌病具有血管侵袭性,恶性度高,感染病原高通量测序有助于早期诊断,以两性霉素B脂质体为主导的药物及手术联合治疗有助于改善预后。Objective To raise awareness of pulmonary mucormycosis in children with leukemia after chemotherapy. Methods The clinical data of a child with acute B-lymphocytic leukemia (B-ALL) complicated with pulmonary mucormycosis after induction chemotherapy were retrospectively analyzed, and the related literatures were reviewed. Results A 2-year-old girl was diagnosed with B-ALL. She developed pulmonary infection and pyopneumothorax in the period of bone marrow suppression after induction of chemotherapy. The clinical manifestations were chest pain and hemoptysis. Pulmonary CT showed right lower lung consolidation. Multiple cultures of sputum and pleural fluid were negative. Rhizopus oryzae was detected in the pleural effusion by high-throughput sequencing of the pathogens on the 22nd day after pneumothorax, and the pathogenic diagnosis was confirmed by fibrobronchoscopic biopsy. Liposomal amphotericin B (LAmB) intravenous infusion and amphotericin B (AmB) aerosol inhalation were given. On the 55th day of pneumothorax, the thoracic drainage tube was removed and the posaconazole was orally administered sequentially. After the treatment for more than 2 months, the lung CT scan showed that the right lower lung consolidation lesions were reduced. Fiberoptic bronchoscopy revealed granulation hyperplasia in the right inferior lobar bronchi. A mirror-assisted argon gas knife cleaning was performed. Posaconazole was orally administered sequentially and the chemotherapy for leukemia was continued. After 10 months, the lung lesions were obviously absorbed. Conclusions Pulmonary mucormycosis has vascular invasiveness and is highly malignant. High throughput sequencing of infectious pathogens is helpful for early diagnosis. The combination of amphotericin B liposomes and surgery can improve prognosis.

关 键 词：白血病 肺毛霉菌病 二代测序 两性霉素B脂质体 泊沙康唑 

分 类 号：R725.6[医药卫生—儿科] R733.7[医药卫生—临床医学]