Abstract：
BACKGROUND: Patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) are susceptible to opportunistic infections, including invasive fungal infections (IFI). This is due to many factors, including prolonged immunosuppressive therapy. The treatment of AAV with such IFIs is challenging.
METHODS: A descriptive analysis of 5 patients with AAV complicated by concomitant invasive fungal infections was performed. We also have done a comprehensive literature review of IFIs in AAV using PubMed and Google Scholar databases.
RESULTS: All 5 patients initially received immunosuppressive medication but subsequently acquired IFI. One patient had sphenoid sinus involvement, and four had lung parenchymal involvement. Aspergillus infection was diagnosed in three patients, Cryptococcus infection in one patient and mixed infection with Aspergillus and Mucor infection in one patient. All our patients were on low doses of corticosteroids for several months to years or had received high-dose pulse steroids with cyclophosphamide in the last few weeks before being diagnosed with IFI. It was difficult to distinguish disease activity from IFI in all the cases. Two of the five patients died despite antifungal therapy. The literature review revealed a prevalence of IFIs ranging from 1 to 9.6% (excluding pneumocystis pneumonia). Aspergillosis was the predominant type of IFI, affecting 46 of 86 patients. Most of these patients (40/46) had pulmonary involvement. The prognosis for patients with IFI was consistently poor, as evidenced by 19 deaths out of 29 reported outcomes.
CONCLUSIONS: Overall, IFIs have a poor prognosis in patients with AAV. Differentiating disease activity from IFI is difficult because of similar organ distribution, imaging lesions, and histopathological characteristics. A high suspicion index and good-quality microbiology are needed for early treatment and prevention of mortality.
METHODS: A descriptive analysis of 5 patients with AAV complicated by concomitant invasive fungal infections was performed. We also have done a comprehensive literature review of IFIs in AAV using PubMed and Google Scholar databases.
RESULTS: All 5 patients initially received immunosuppressive medication but subsequently acquired IFI. One patient had sphenoid sinus involvement, and four had lung parenchymal involvement. Aspergillus infection was diagnosed in three patients, Cryptococcus infection in one patient and mixed infection with Aspergillus and Mucor infection in one patient. All our patients were on low doses of corticosteroids for several months to years or had received high-dose pulse steroids with cyclophosphamide in the last few weeks before being diagnosed with IFI. It was difficult to distinguish disease activity from IFI in all the cases. Two of the five patients died despite antifungal therapy. The literature review revealed a prevalence of IFIs ranging from 1 to 9.6% (excluding pneumocystis pneumonia). Aspergillosis was the predominant type of IFI, affecting 46 of 86 patients. Most of these patients (40/46) had pulmonary involvement. The prognosis for patients with IFI was consistently poor, as evidenced by 19 deaths out of 29 reported outcomes.
CONCLUSIONS: Overall, IFIs have a poor prognosis in patients with AAV. Differentiating disease activity from IFI is difficult because of similar organ distribution, imaging lesions, and histopathological characteristics. A high suspicion index and good-quality microbiology are needed for early treatment and prevention of mortality.
摘要：
背景：抗中性粒细胞胞浆抗体相关血管炎（AAV）患者易受机会性感染，包括侵袭性真菌感染（IMF）。这是由于许多因素，包括长期免疫抑制治疗.用这样的IFIs治疗AAV是具有挑战性的。
方法：对5例AAV并发侵袭性真菌感染患者进行描述性分析。我们还使用PubMed和GoogleScholar数据库对AAV中的IFIs进行了全面的文献综述。
结果：所有5例患者最初都接受了免疫抑制药物治疗，但随后获得了FI。一名患者受累蝶窦,其中4例有肺实质受累.3名患者被确诊为曲霉菌感染,1例隐球菌感染，1例曲霉菌和毛霉混合感染。我们所有的患者都服用低剂量的皮质类固醇几个月到几年，或者在被诊断为FI之前的最后几周接受了高剂量的脉冲类固醇和环磷酰胺。在所有情况下，很难区分疾病活动和国际金融机构。尽管进行了抗真菌治疗，但五名患者中有两名死亡。文献综述显示，IFIs的患病率为1％至9.6％（不包括肺囊虫肺炎）。曲霉菌病是主要的FI类型，影响86名患者中的46名。这些患者中的大多数（40/46）有肺部受累。FI患者的预后一直很差，29例报告结局中有19例死亡证明.
结论：总体而言，AAV患者的IFIs预后不良。由于相似的器官分布，很难区分疾病活动和FI，影像学病变,和组织病理学特征。早期治疗和预防死亡需要高怀疑指数和高质量的微生物学。
方法：对5例AAV并发侵袭性真菌感染患者进行描述性分析。我们还使用PubMed和GoogleScholar数据库对AAV中的IFIs进行了全面的文献综述。
结果：所有5例患者最初都接受了免疫抑制药物治疗，但随后获得了FI。一名患者受累蝶窦,其中4例有肺实质受累.3名患者被确诊为曲霉菌感染,1例隐球菌感染，1例曲霉菌和毛霉混合感染。我们所有的患者都服用低剂量的皮质类固醇几个月到几年，或者在被诊断为FI之前的最后几周接受了高剂量的脉冲类固醇和环磷酰胺。在所有情况下，很难区分疾病活动和国际金融机构。尽管进行了抗真菌治疗，但五名患者中有两名死亡。文献综述显示，IFIs的患病率为1％至9.6％（不包括肺囊虫肺炎）。曲霉菌病是主要的FI类型，影响86名患者中的46名。这些患者中的大多数（40/46）有肺部受累。FI患者的预后一直很差，29例报告结局中有19例死亡证明.
结论：总体而言，AAV患者的IFIs预后不良。由于相似的器官分布，很难区分疾病活动和FI，影像学病变,和组织病理学特征。早期治疗和预防死亡需要高怀疑指数和高质量的微生物学。
