PDF(Pubmed)
Abstract：
BACKGROUND: Gastrointestinal mucormycosis is a rapidly progressing and often fatal disease, predominantly affecting immunocompromised patients. Surgical intervention, in addition to antifungal therapy, is essential. Herein, we describe the successful management of appendiceal mucormycosis in a patient with acute promyelocytic leukemia through rapid surgical intervention and antifungal therapy.
METHODS: A 29-year-old woman underwent autologous peripheral blood stem cell transplantation for acute promyelocytic leukemia (APL). Subsequently, her condition relapsed, and remission induction therapy was initiated. During the immunosuppressive period, she developed a fever and severe abdominal pain. Computed tomography revealed severe edema of the ileum, cecum, and ascending colon. Despite receiving multiple antibiotics, antivirals, and antifungals, her condition showed no improvement. Consequently, she underwent exploratory laparotomy, with no bowel perforation noted, revealing severe inflammation in the ileum, cecum, and ascending colon, as well as appendiceal necrosis. Appendectomy was performed, and histopathological analysis revealed hyphae in the vessels and layers of the appendiceal wall, suggestive of mucormycosis. The patient was diagnosed with appendiceal mucormycosis, and liposomal amphotericin B was administered. Subsequent monitoring showed no recurrence of mucormycosis. Genetic analysis of the resected tissue revealed Rhizopus microspores as the causative agent.
CONCLUSIONS: Rapid surgical intervention and antifungal drug administration proved successful in managing appendiceal mucormycosis in a patient with APL. Early recognition and aggressive surgical intervention are imperative to improve outcomes in such patients.
METHODS: A 29-year-old woman underwent autologous peripheral blood stem cell transplantation for acute promyelocytic leukemia (APL). Subsequently, her condition relapsed, and remission induction therapy was initiated. During the immunosuppressive period, she developed a fever and severe abdominal pain. Computed tomography revealed severe edema of the ileum, cecum, and ascending colon. Despite receiving multiple antibiotics, antivirals, and antifungals, her condition showed no improvement. Consequently, she underwent exploratory laparotomy, with no bowel perforation noted, revealing severe inflammation in the ileum, cecum, and ascending colon, as well as appendiceal necrosis. Appendectomy was performed, and histopathological analysis revealed hyphae in the vessels and layers of the appendiceal wall, suggestive of mucormycosis. The patient was diagnosed with appendiceal mucormycosis, and liposomal amphotericin B was administered. Subsequent monitoring showed no recurrence of mucormycosis. Genetic analysis of the resected tissue revealed Rhizopus microspores as the causative agent.
CONCLUSIONS: Rapid surgical intervention and antifungal drug administration proved successful in managing appendiceal mucormycosis in a patient with APL. Early recognition and aggressive surgical intervention are imperative to improve outcomes in such patients.
摘要：
背景：胃肠道毛霉菌病是一种进展迅速且通常致命的疾病，主要影响免疫功能低下的患者。手术干预,除了抗真菌治疗，是必不可少的。在这里，我们描述了通过快速手术干预和抗真菌治疗成功治疗急性早幼粒细胞白血病患者阑尾毛霉菌病的方法.
方法：一名29岁女性接受自体外周血干细胞移植治疗急性早幼粒细胞白血病（APL）。随后，她的病情复发了,并开始缓解诱导治疗。在免疫抑制期,她出现了发烧和严重的腹痛。计算机断层扫描显示回肠严重水肿，盲肠,和升结肠。尽管接受了多种抗生素，抗病毒药物,和抗真菌药，她的病情没有好转。因此,她做了剖腹探查术,没有发现肠穿孔,回肠有严重的炎症,盲肠,和升结肠，以及阑尾坏死。进行阑尾切除术,组织病理学分析显示阑尾壁的血管和层有菌丝，提示毛霉菌病。病人被诊断为阑尾毛霉菌病,并给予脂质体两性霉素B。随后的监测显示毛霉菌病没有复发。切除组织的遗传分析显示根霉小孢子是病原体。
结论：快速手术干预和抗真菌药物的给药被证明在治疗1例APL患者的阑尾毛霉菌病方面是成功的。早期识别和积极的手术干预对于改善此类患者的预后至关重要。
方法：一名29岁女性接受自体外周血干细胞移植治疗急性早幼粒细胞白血病（APL）。随后，她的病情复发了,并开始缓解诱导治疗。在免疫抑制期,她出现了发烧和严重的腹痛。计算机断层扫描显示回肠严重水肿，盲肠,和升结肠。尽管接受了多种抗生素，抗病毒药物,和抗真菌药，她的病情没有好转。因此,她做了剖腹探查术,没有发现肠穿孔,回肠有严重的炎症,盲肠,和升结肠，以及阑尾坏死。进行阑尾切除术,组织病理学分析显示阑尾壁的血管和层有菌丝，提示毛霉菌病。病人被诊断为阑尾毛霉菌病,并给予脂质体两性霉素B。随后的监测显示毛霉菌病没有复发。切除组织的遗传分析显示根霉小孢子是病原体。
结论：快速手术干预和抗真菌药物的给药被证明在治疗1例APL患者的阑尾毛霉菌病方面是成功的。早期识别和积极的手术干预对于改善此类患者的预后至关重要。
