急性白血病继发热带念珠菌骨髓炎1例并文献复习  

Acute Leukemia Complicated with Tropical Candida Osteomyelitis:a Case Report and Literature Review

作　　者：郑震罡 刘芳 孟庆彩 付建珠 成志勇[4] 柳倩[4] 张娇 ZHENG Zhen-gang;LIU Fang;MENG Qing-cai;FU Jian-zhu;CHENG Zhi-yong;LIU Qian;ZHANG Jiao(Department of Infectious diseases,Ding Zhou People’s Hospital,Dingzhou 073000,China;Department of Pathology,Baoding Children’s Hospital,Baoding 071000,China;epartment of Laboratory,Baoding No.1 Hospital,Baoding 071000,China;Department of Hematology,Baoding No.1 Hospital,Baoding 071000,China)

机构地区：[1]定州市人民医院感染性疾病科,河北定州073000 [2]保定市儿童医院病理科,河北保定071000 [3]保定市第一医院检验科,河北保定071000 [4]保定市第一医院血液内科,河北保定071000

出　　处：《南昌大学学报（医学版）》2024年第6期103-106,共4页Journal of Nanchang University：Medical Sciences

基　　金：河北省适用跟踪计划项目(G2018091);河北省重点研发计划项目(223777105D)。

摘　　要：目的报告1例急性白血病化疗后伴有严重播散性热带念珠菌血症并侵犯多脏器病例,为进一步治疗侵袭性真菌感染积累临床经验。方法查阅国内外相关文献,对1例白血病化疗后侵袭性真菌病患者临床诊疗进行回顾性分析。结果患者男性,59岁,诊断为急性髓系白血病,给予多次大剂量阿糖胞苷化疗后,出现严重骨髓抑制、播散性热带念珠菌血症,导致肋骨骨髓炎及肋软骨炎及胸壁脓肿。经病灶清除术联合两性霉素B+卡泊芬净及氟尿嘧啶治疗后病情稳定。结论化疗后骨髓抑制期播散性热带念珠菌血症,导致肋(软)骨炎,进一步侵犯周围组织,需要与骨结核、白血病髓外浸润鉴别,同时手术联合足疗程抗真菌治疗才能达到治愈目的。Objective To analyze a case of acute leukemia complicated with severe disseminated tropical candidemia and multiple organ invasion after chemotherapy so as to accumulate clinical experience for invasive fungal infections.Methods Relevant domestic and international literature was reviewed,and a retrospective analysis was conducted of clinical diagnosis and treatment of a patient with invasive fungal disease after leukemia chemotherapy.Results The patient,a 59-year-old male diagnosed with acute myeloid leukemia,developed severe myelosuppression and disseminated tropical candidemia after receiving multiple high-dose cytarabine chemotherapy,resulting in rib osteomyelitis,costochondritis,and chest wall abscess.The patient’s condition stabilized after undergoing focal debridement combined with amphotericin B,caspofungin,and fluorouracil treatment.Conclusion Disseminated tropical candidemia during the myelosuppression phase after chemotherapy can lead to costochondritis and further invasion of surrounding tissues,and it is necessary to differentiate this condition from bone tuberculosis and extramedullary infiltration of leukemia;simultaneously,a combination of surgical intervention and adequate antifungal therapy is required to achieve an effective therapeutic effect.

关 键 词：热带念珠菌 白血病 骨髓炎 真菌血症 

分 类 号：R733.71[医药卫生—肿瘤] R639[医药卫生—临床医学]