新冠肺炎治疗引发糖尿病酮症酸中毒合并鼻眶脑型毛霉菌病 1 例并文献复习

COVID-19 treatment-induced diabetic ketoacidosis combined with rhino-orbital cerebral mucormycosis:a case report and literature review

摘要

目的 探讨鼻眶脑型毛霉菌病的临床特征及综合治疗方法。方法 回顾性分析 1 例鼻眶脑型毛霉菌病患者的临床资料，并对其临床特征、诊断及治疗方法进行总结。结果 本例患者术后细菌及真菌培养提示耐甲氧西林表皮葡萄球菌及丝状真菌感染，利奈唑胺、伏立康唑抗感染治疗效果不佳，复送真菌培养考虑毛霉菌感染，给予艾沙康唑治疗，随访 6 个月，患者左侧眶周肿胀及疼痛消失，左眼睑上提功能完全恢复，视力仍无改善。结论 鼻腔鼻窦的丝状真菌感染有时不易明确其具体种类，需反复送检，早期明确真菌感染类型可为该类疾病的综合治疗争取宝贵时间。鼻眶脑型毛霉菌病进展迅速，及时手术及针对毛霉菌进行抗真菌治疗可有效控制病情进展。

Abstract

Objective To study the clinical characteristics and comprehensive management of rhino-orbital cerebral mucormycosis. Methods A retrospective analysis of the clinical data of patients with rhino-orbital cerebral mucormycosis was performed, summarizing the clinical features, diagnosis and treatment methods. Results Postoperative bacterial and fungal cultures suggested methicillin-resistant Staphylococcus epidermidis and filamentous fungal infection. Linezolid and voriconazole were not effective in treating the disease. After a repeat fungal culture, the patient was considered to have a Mucor infection and was treated with isavuconazole. After 6 months of follow-up, the swelling and pain in the left orbital area had disappeared and the left eyelid elevation function had fully recovered. However, vision did not improve. Conclusion The specific type of filamentous fungal infection of the nasal cavity and sinuses is sometimes difficult to identify and requires repeated testing. Early identification of the type of fungal infection can save valuable time in the comprehensive treatment of this disease. Rhino-orbital cerebral mucormycosis progresses rapidly, and timely surgical intervention and antifungal treatment of mucormycosis can effectively control the progression of the disease.

关键词

毛霉菌病 / 鼻窦疾病 / 眶内并发症 / 内镜手术 / 综合治疗

Key words

Mucormycosis / Sinus disease / Intraorbital complications / Endoscopic surgery / Comprehensive treatment

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基金资助

国家自然科学基金面上项目(82271147)