以双侧颅神经麻痹为临床表现的鼻眶脑毛霉菌病的临床特点(附1例报告)  

Clinical features of rhino-orbital-cerebral mucormycosis with bilateral cranial nerves paralyze as the clinical manifestation(report of one case)

作　　者：郑晓彧 杨洪娜[1] 方巍 ZHENG Xiaoyu;YANG Hongna;FANG Wei(Department of Critical-Care Medicine,Shandong Provincial Hospital,Shandong University,Jinan 250000,China)

机构地区：[1]山东大学山东省立医院重症医学科,济南250000 [2]山东第一医科大学附属省立医院重症医学科

出　　处：《临床神经病学杂志》2024年第2期109-112,共4页Journal of Clinical Neurology

基　　金：国家自然科学基金(81701057)。

摘　　要：目的探讨以双侧颅神经麻痹为临床表现的鼻眶脑毛霉菌病(ROCM)的临床特点。方法回顾性分析1例以双侧颅神经麻痹为临床表现的ROCM患者的临床资料,并结合相关文献进行分析讨论。结果本例患者青年男性,既往体健,有新发糖尿病及糖尿病酮症酸中毒。该患者急性起病,进展迅速,出现双眼失明、双上眼睑下垂和眼外肌麻痹,CSF二代测序、真菌荧光染色涂片和培养均证实存在毛霉菌。虽然早期积极给予有效抗真菌治疗,但是患者迅速出现脑出血及脑疝,最终自动出院后死亡。结论ROCM是罕见的高死亡率感染性疾病。对于糖尿病/糖尿病酮症酸中毒患者,当双侧颅神经麻痹作为临床症状且不能用其他病变解释时,建议考虑是否存在ROCM。CSF二代测序有助于快速诊断。Objective To investigate the clinical features of rhino-orbital-cerebral mucormycosis(ROCM)with bilateral cranial nerve palsies as the clinical manifestation.Methods The related clinical data about ROCM with bilateral cranial nerve palsy as a clinical manifestation was collected,analyzed as well as discussed in the manuscript.And the relevant literatures were reviewed.Results This patient was a healthy young man with new-onset diabetes and diabetic ketoacidosis.The patient developed rapidly with acute onset,bilateral blindness,blepharoptosis and extraocular muscle paralysis.The presence of mucormycosis was confirmed by CSF second-generation sequencing,fungal fluorescent staining and culture.Although effective antifungal therapy was performed early,but the patient quickly presented with cerebral hemorrhage and herniation.Eventually,the patient died after discharge.Conclusions ROCM is a rare and high-mortality infectious disease.This case indicated that the clinicians should consider the presence of ROCM in patients with diabetes/diabetic ketoacidosis when the bilateral cranial nerves paralysis are the clinical symptom,whicn can not be explained by other lesions.CSF next-generation sequencing is helpful for rapid diagnosis.

关 键 词：鼻眶脑毛霉菌病 双侧颅神经麻痹 脑出血 二代测序 糖尿病酮症酸中毒 

分 类 号：R519[医药卫生—内科学]