鼻眶脑型毛霉病继发双侧前循环脑梗死1例  

A case of rhino-orbito-cerebral mucormycosis complicated with bilateral anterior circulation cerebral infarction

作　　者：郭玉坤 侯晋 王建 李恒 Guo Yukun;Hou Jin;Wang Jian;Li Heng(Cheeloo College of Medicine,Shandong University,Jinan 250012,China;Department of Neurology,Central Hospital Affiliated to Shandong First Medical University,Jinan 250013,China;Department of Radiology,Central Hospital Affiliated to Shandong First Medical University,Jinan 250013,China)

机构地区：[1]山东大学齐鲁医学院,济南250012 [2]山东第一医科大学附属中心医院神经内科,济南250013 [3]山东第一医科大学附属中心医院放射科,济南250013

出　　处：《中华神经科杂志》2024年第1期70-74,共5页Chinese Journal of Neurology

摘　　要：鼻眶脑型毛霉病(ROCM)是一种急性、进展快速、病情凶险的机会性真菌感染疾病,早期临床表现不典型,容易漏诊误诊,合并脑血管病变患者病死率极高。文中报道1例山东第一医科大学附属中心医院收治的患者,为47岁女性,合并糖尿病酮症酸中毒和新型冠状病毒肺炎,主要表现为发热、进行性加重的意识障碍、眶尖综合征和偏瘫,通过影像学表现结合脑脊液宏基因组二代测序手段确诊为米根霉所致的ROCM,给予两性霉素B胆固醇硫酸酯复合物联合艾沙康唑抗真菌治疗,后期并发右侧颈内动脉和双侧大脑前动脉闭塞,最终因重症脑梗死及肺部感染而死亡。报道本病例旨在阐述ROCM继发缺血性脑血管病变的特点和双侧前循环梗死的少见情况及诊治方法。Rhino-orbito-cerebral mucormycosis(ROCM)is an acute,rapidly progressive,and lethal opportunistic fungal disease.Due to the atypical clinical manifestations,the disease is easily misdiagnosed in the early stage.The patients with ROCM associated cerebrovascular complications generally have a high mortality rate.This article reports a 47-year-old female patient with diabetic ketoacidosis and COVID-19 admitted to Central Hospital Affiliated to Shandong First Medical University.The results of radiological examinations and cerebrospinal fluid metagenomic next-generation sequencing confirmed as Rhizopus oryzae associated ROCM.In spite of receiving amphotericin B colloidal dispersion and isavuconazole treatments,the patient died of ROCM complicated with severe cerebral infarctions and pulmonary infection.The purpose of this case report is to summarize the clinical characteristics of ROCM with cerebrovascular ischemic events and the rare condition of bilateral anterior circulation involvements,and introduce recent diagnostic and therapeutic approaches for this disease.

关 键 词：毛霉菌病 脑梗死 新型冠状病毒感染 高通量测序 

分 类 号：R519[医药卫生—内科学] R743.3[医药卫生—临床医学]