PDF(Pubmed)
Abstract：
UNASSIGNED: Fungal infections in neonates, particularly primary cutaneous aspergillosis (PCA), pose significant risks to premature infants with very low birth weight. This report chronicles the case of a 22-week gestational age female, with a birth weight of 430 g, who developed extensive cutaneous aspergillosis leading to extremity compartment syndrome- a first in the medical and surgical literature.
METHODS: A female micro preemie born at 22 weeks and 2 days was critically ill during her first week of life. On first day of life, attempts were made to establish intravenous access in all extremities. Eventually, the neonatal team established a peripherally inserted central catheter (PICC) in the left upper extremity. She had surfactant therapy due to lung immaturity and was on high frequency oscillatory ventilation. A large patent ductus arteriosus was treated soon after birth with intravenous acetaminophen. On day seven of life, she developed skin blisters rapidly progressing to necrotic eschars, particularly on the right lower extremity, leading to compromised limb circulation. Consultations with pediatric surgery and orthopedics one week later resulted in bedside medial and lateral escharotomies to salvage the limb. Tissue biopsy confirmed Aspergillus species, prompting a dual antifungal treatment with liposomal Amphotericin B and Voriconazole. The lesions gradually resolved with diligent wound care and aggressive physical therapy, yet a residual contracture of the right foot\'s dorsal area persisted, necessitating splinting.
UNASSIGNED: Over the course of treatment, her cutaneous lesions resolved, and no further debridement was required. Aggressive physical therapy was initiated for residual contractures that the infant developed due to full thickness necrosis of the cutaneous infection. Due to concurrent pulmonary complications and tracheomalacia, surgical intervention for the contracture has been postponed.
CONCLUSIONS: This case highlights the critical importance of early detection and treatment of PCA in preterm infants, the challenges in managing complex cases in the NICU and the need for a multidisciplinary approach to care.
METHODS: A female micro preemie born at 22 weeks and 2 days was critically ill during her first week of life. On first day of life, attempts were made to establish intravenous access in all extremities. Eventually, the neonatal team established a peripherally inserted central catheter (PICC) in the left upper extremity. She had surfactant therapy due to lung immaturity and was on high frequency oscillatory ventilation. A large patent ductus arteriosus was treated soon after birth with intravenous acetaminophen. On day seven of life, she developed skin blisters rapidly progressing to necrotic eschars, particularly on the right lower extremity, leading to compromised limb circulation. Consultations with pediatric surgery and orthopedics one week later resulted in bedside medial and lateral escharotomies to salvage the limb. Tissue biopsy confirmed Aspergillus species, prompting a dual antifungal treatment with liposomal Amphotericin B and Voriconazole. The lesions gradually resolved with diligent wound care and aggressive physical therapy, yet a residual contracture of the right foot\'s dorsal area persisted, necessitating splinting.
UNASSIGNED: Over the course of treatment, her cutaneous lesions resolved, and no further debridement was required. Aggressive physical therapy was initiated for residual contractures that the infant developed due to full thickness necrosis of the cutaneous infection. Due to concurrent pulmonary complications and tracheomalacia, surgical intervention for the contracture has been postponed.
CONCLUSIONS: This case highlights the critical importance of early detection and treatment of PCA in preterm infants, the challenges in managing complex cases in the NICU and the need for a multidisciplinary approach to care.
摘要：
■新生儿真菌感染，特别是原发性皮肤曲霉病（PCA），对极低出生体重的早产儿构成重大风险。本报告记录了一名22周胎龄女性的病例，出生体重为430克，他发展为广泛的皮肤曲霉病，导致四肢间隔综合征-这是医学和外科文献中的第一个。
方法：一名22周零2天出生的女性微型早产儿在其生命的第一周内病情危重。生命的第一天，尝试在所有四肢建立静脉通路。最终,新生儿团队在左上肢建立了外周中心静脉置管(PICC).由于肺不成熟，她接受了表面活性剂治疗，并且正在进行高频振荡通气。出生后不久，静脉注射对乙酰氨基酚治疗了大的动脉导管未闭。在生命的第七天，她出现了皮肤水泡，迅速发展为坏死的结焦，尤其是右下肢,导致肢体循环受损。一周后，经过儿科手术和骨科的咨询，在床边进行了内侧和外侧切开术，以挽救肢体。组织活检证实曲霉属，提示脂质体两性霉素B和伏立康唑双重抗真菌治疗。通过勤奋的伤口护理和积极的物理治疗，病变逐渐解决，然而，右脚背侧区域的残余挛缩持续存在，需要夹板。
■在治疗过程中，她的皮肤损伤解决了,并且不需要进一步的清创。针对婴儿由于皮肤感染的全层坏死而发展的残余挛缩，开始了积极的物理疗法。由于并发肺部并发症和气管软化，挛缩的手术干预已被推迟。
结论：该案例强调了早期发现和治疗早产儿PCA的重要性，在NICU管理复杂病例的挑战和需要多学科的方法来照顾。
方法：一名22周零2天出生的女性微型早产儿在其生命的第一周内病情危重。生命的第一天，尝试在所有四肢建立静脉通路。最终,新生儿团队在左上肢建立了外周中心静脉置管(PICC).由于肺不成熟，她接受了表面活性剂治疗，并且正在进行高频振荡通气。出生后不久，静脉注射对乙酰氨基酚治疗了大的动脉导管未闭。在生命的第七天，她出现了皮肤水泡，迅速发展为坏死的结焦，尤其是右下肢,导致肢体循环受损。一周后，经过儿科手术和骨科的咨询，在床边进行了内侧和外侧切开术，以挽救肢体。组织活检证实曲霉属，提示脂质体两性霉素B和伏立康唑双重抗真菌治疗。通过勤奋的伤口护理和积极的物理治疗，病变逐渐解决，然而，右脚背侧区域的残余挛缩持续存在，需要夹板。
■在治疗过程中，她的皮肤损伤解决了,并且不需要进一步的清创。针对婴儿由于皮肤感染的全层坏死而发展的残余挛缩，开始了积极的物理疗法。由于并发肺部并发症和气管软化，挛缩的手术干预已被推迟。
结论：该案例强调了早期发现和治疗早产儿PCA的重要性，在NICU管理复杂病例的挑战和需要多学科的方法来照顾。
