异基因造血干细胞移植后鼻-眶-脑毛霉菌病2例并文献复习  

Rhino-orbital-cerebral mucormycosis after allogeneic hematopoietic stem cell transplantation:Report of 2 cases with literature review

作　　者：王娜娜 黄辰 黄君 王然 严家炜 杨玉琼 黄东平 WANG Nana;HUANG Chen;HUANG Jun;WANG Ran;YAN Jiawei;YANG Yuqiong;HUANG Dongping(Department of Hematology,The First Affiliated Hospital of Wannan Medical College,Wuhu 241001,Anhui,China)

机构地区：[1]皖南医学院第一附属医院,弋矶山医院血液内科,安徽芜湖241001

出　　处：《皖南医学院学报》2024年第6期610-612,共3页Journal of Wannan Medical College

基　　金：安徽省高等学校科学研究项目(2023AH040255);皖南医学院中青年科研基金项目(WK2023ZQNZ42);皖南医学院活性生物大分子点重点实验室开放课题(LAB202201)。

摘　　要：目的:总结异基因造血干细胞移植后合并鼻-眶-脑毛霉菌病患者的临床特征、诊断、治疗及预后,以指导临床诊疗工作。方法:回顾性分析弋矶山医院血液内科2021年5月~2022年12月诊治的2例异基因造血干细胞移植后合并鼻-眶-脑毛霉菌病患者的临床资料,并复习相关文献。结果:2例患者均为恶性血液病,异基因造血干细胞移植后合并急性或慢性移植物抗宿主病(GVHD),使用免疫抑制剂;2例患者起病时均以眼周表现为主,均有鼻窦炎症,并迅速进展致昏迷。外周血病原微生物宏基因测序(mNGS)检测出毛霉菌。2例患者接受两性霉素B脂质体单药或联合泊沙康唑治疗,最终病情进展而死亡。结论:鼻-眶-脑型毛霉菌病患者病情进展迅速,病死率高,需早期诊断,尽早应用系统性抗真菌药物联合手术治疗或可改善患者预后。Objective:To analyze the clinical characteristics,diagnosis,treatment and prognosis of patients with rhino-orbital-cerebral mucormycosis after allogeneic hematopoietic stem cell transplantation(allo-HSCT)for following clinical practice guidance.Methods:The clinical data were retrospectively analyzed in two cases of rhino-orbital-cerebral mucormycosis after allo-HSCT who were diagnosed and treated in our department between May 2021 and December 2022,and the related literatures were reviewed.Results:Both patients were diagnosed with hematologic malignancies and developed acute or chronic graft-versus-host disease(GVHD)following allo-HSCT,and underwent immunosuppressive therapy.Both of them presented mainly with ocular symptoms at onset,had sinusitis,and rapidly progressed to coma.Mucor was detected in the peripheral blood by metagenomics next-generation sequencing(mNGS).Unfortunately,both patients eventually die due to condition progression even though they were treated with simple amphotericin B liposomes or in combination with posaconazole.Conclusion:Patients with rhino-orbital-cerebral mucormycosis may have rapid disease progression and high mortality,requiring early diagnosis,systemic antifungal drugs combined with surgical treatment.

关 键 词：异基因造血干细胞移植 鼻-眶-脑毛霉菌病 诊断 治疗 

分 类 号：R457.7[医药卫生—治疗学] R519[医药卫生—临床医学]