鼻-眶-脑米根霉菌病1例  

A case report of rhino-orbital-cerebral mycosis caused by Rhizopus oryzae

作　　者：罗秋雁 杨婕 陈伟栋[1] 周鸿雁[1] 冯慧宇[1] 陈玲[1] 冯黎[1] LUO Qiuyan;YANG Jie;CHEN Weidong;ZHOU Hongyan;FENG Huiyu;CHEN Ling;FENG Li(Department of Neurology,the First Affiliated Hospital,Sun Yat-sen University,Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases,National Key Clinical Department and Key Discipline of Neurology,No.58 Zhongshan Road 2,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院神经科,广东省重大神经疾病诊治研究重点实验室,国家临床重点专科和国家重点学科,广州510080

出　　处：《中国神经精神疾病杂志》2022年第12期737-740,共4页Chinese Journal of Nervous and Mental Diseases

基　　金：广东省重大神经疾病诊治研究重点实验室(编号:2020B1212060017);广东省神经系统疾病临床医学研究中心(编号:2020B1111170002);华南神经疾病早期干预及功能修复研究国际联合研究中心(编号:2015B050501003,2020A0505020004);广东省神经系统重大疾病诊治工程技术研究中心;广东省神经系统重大疾病诊治转化医学创新平台和广州市神经系统重大疾病临床医学研究与转化中心(编号:201604020010)。

摘　　要：鼻-眶-脑米根霉菌病是米根霉菌同时侵袭鼻窦、眼部及颅内所导致的感染,其作为脑梗死的罕见病因在早期常被忽略,最终导致不良结局。本文报告1例由米根霉感染所导致的鼻-眶-脑米根霉菌病,患者既往有鼻窦炎手术及糖尿病病史,随后出现迅速进展的意识障碍,以双侧大脑前动脉脑梗死收入院,在鼻窦活检、鼻拭子、脑脊液及血液中均检出米根霉。确诊后对患者进行了两性霉素B脂质体静脉注射及两性霉素B鞘内注射治疗,联合静脉应用泊沙康唑,并联合耳鼻喉科行鼻内镜下鼻窦病变清除+双侧鼻窦开放术,患者曾有一过性好转,最终死于感染性休克。Rhino-orbital-cerebral mucormycosis is an infection caused by Mucor invading the paranasal sinuses,eyes,and intracranial space at the same time.As a rare cause of cerebral infarction,Rhino-orbital-cerebral mucormycosis is often ignored in the early stage and eventually leads to adverse outcomes.This report presented a case of rhino-orbital-cerebral mycosis caused by Rhizopus oryzae infection.The patient was admitted to the ICU with a history of sinusitis surgery and diabetes,followed by rapid progressive cerebral infarction and disturbance of consciousness.R.oryzae was detected by metagenomic next-generation sequencing(mNGS)of cerebrospinal fluid,blood,and nasal swab samples,confirmed by following sinus biopsy.The treatment was then adjusted to intravenous injection of amphotericin B liposome and intrathecal injection of amphotericin B,combined with intravenous application of posaconazole endoscopic sinus lesion removal,and open sinus surgery.The patient eventually died of septic shock.

关 键 词：颅内感染 真菌感染 米根霉 脑梗死 酮症酸中毒 

分 类 号：R741[医药卫生—神经病学与精神病学]