PDF(Pubmed)
Abstract：
UNASSIGNED: In patients with poorly controlled diabetes, early recognition of rare fungal infections like pulmonary mucormycosis, especially when presenting with unusual complications such as broncho-esophageal fistula, is critical. Prompt intervention with antifungal therapy and consideration for surgical debridement significantly impact outcomes. Multidisciplinary management is paramount for such complex cases.
UNASSIGNED: Mucormycosis is a rare fungal infection caused by the Mucorales. This infection is mostly observed among those with poorly controlled diabetes or immunodeficiency. The most common presentation of the infection among those with poorly controlled diabetes is rhino-orbit-cerebral involvement. In this case report, we provide the history and outcome of a rare case of pulmonary mucormycosis in a patient with poorly controlled diabetes who was simultaneously diagnosed with broncho-esophageal fistula. Our patient was a 32-year-old male with a history of poorly controlled diabetes. Over the months, he had complained of productive coughs and dyspnea, which had lately been joined by dysphagia. He also claimed to have lost considerable weight (10 kg) during the previous 3 months. Barium swallow showed an abnormal flow of contrast between the bronchus and esophagus, suggesting a broncho-esophageal fistula. Computed tomography of the thorax revealed a broncho-esophageal fistula between the left main bronchus (LMB) and esophagus. He had a bronchoscopy the next day, which revealed necrosis and a broncho-esophageal fistula in the LMB. A bronchial biopsy showed typical hyphae with necrotic tissue, indicating mucormycosis. The patient\'s antimycotic medication (liposomal amphotericin) was started and a prompt surgery consult was ordered. The patient, however, passed away from massive hemoptysis. We described a rare case of pulmonary mucormycosis with broncho-esophageal fistula in a patient with poorly controlled diabetes. The rarity of this combination highlights the associated diagnostic and treatment hurdles. Early detection, antifungal medication, as soon as possible surgical debridement of involved tissues, and a multidisciplinary approach could improve patient outcomes.
UNASSIGNED: Mucormycosis is a rare fungal infection caused by the Mucorales. This infection is mostly observed among those with poorly controlled diabetes or immunodeficiency. The most common presentation of the infection among those with poorly controlled diabetes is rhino-orbit-cerebral involvement. In this case report, we provide the history and outcome of a rare case of pulmonary mucormycosis in a patient with poorly controlled diabetes who was simultaneously diagnosed with broncho-esophageal fistula. Our patient was a 32-year-old male with a history of poorly controlled diabetes. Over the months, he had complained of productive coughs and dyspnea, which had lately been joined by dysphagia. He also claimed to have lost considerable weight (10 kg) during the previous 3 months. Barium swallow showed an abnormal flow of contrast between the bronchus and esophagus, suggesting a broncho-esophageal fistula. Computed tomography of the thorax revealed a broncho-esophageal fistula between the left main bronchus (LMB) and esophagus. He had a bronchoscopy the next day, which revealed necrosis and a broncho-esophageal fistula in the LMB. A bronchial biopsy showed typical hyphae with necrotic tissue, indicating mucormycosis. The patient\'s antimycotic medication (liposomal amphotericin) was started and a prompt surgery consult was ordered. The patient, however, passed away from massive hemoptysis. We described a rare case of pulmonary mucormycosis with broncho-esophageal fistula in a patient with poorly controlled diabetes. The rarity of this combination highlights the associated diagnostic and treatment hurdles. Early detection, antifungal medication, as soon as possible surgical debridement of involved tissues, and a multidisciplinary approach could improve patient outcomes.
摘要：
■在糖尿病控制不佳的患者中，早期识别罕见的真菌感染，如肺毛霉菌病，特别是当出现不寻常的并发症，如支气管食管瘘时，是至关重要的。及时干预抗真菌治疗和考虑手术清创术显著影响预后。对于如此复杂的案件，多学科管理至关重要。
■毛霉菌病是由毛霉菌病引起的一种罕见的真菌感染。这种感染主要在那些控制不佳的糖尿病或免疫缺陷患者中观察到。在控制不佳的糖尿病患者中，最常见的感染表现是犀牛-眼眶-脑受累。在这个案例报告中,我们提供了一例罕见的肺毛霉菌病病例的病史和结果,该病例患有控制不佳的糖尿病,同时被诊断为支气管食管瘘.我们的患者是一名32岁的男性，糖尿病控制不佳。几个月来,他抱怨咳嗽和呼吸困难，最近还伴有吞咽困难。他还声称在过去的3个月中体重减轻了相当多（10公斤）。钡吞咽显示支气管和食道之间的反差异常，提示支气管食管瘘.胸部计算机断层扫描显示左主支气管（LMB）和食道之间存在支气管食管瘘。第二天他做了支气管镜检查,显示LMB中的坏死和支气管食管瘘。支气管活检显示典型菌丝伴坏死组织，表明毛霉菌病.开始患者的抗真菌药物（脂质体两性霉素），并要求及时进行手术咨询。病人,然而,死于大咯血.我们描述了一例控制不佳的糖尿病患者的肺部毛霉菌病伴支气管食管瘘的罕见病例。这种组合的稀有性突出了相关的诊断和治疗障碍。及早发现,抗真菌药物,尽快对受累组织进行手术清创，多学科方法可以改善患者预后.
■毛霉菌病是由毛霉菌病引起的一种罕见的真菌感染。这种感染主要在那些控制不佳的糖尿病或免疫缺陷患者中观察到。在控制不佳的糖尿病患者中，最常见的感染表现是犀牛-眼眶-脑受累。在这个案例报告中,我们提供了一例罕见的肺毛霉菌病病例的病史和结果,该病例患有控制不佳的糖尿病,同时被诊断为支气管食管瘘.我们的患者是一名32岁的男性，糖尿病控制不佳。几个月来,他抱怨咳嗽和呼吸困难，最近还伴有吞咽困难。他还声称在过去的3个月中体重减轻了相当多（10公斤）。钡吞咽显示支气管和食道之间的反差异常，提示支气管食管瘘.胸部计算机断层扫描显示左主支气管（LMB）和食道之间存在支气管食管瘘。第二天他做了支气管镜检查,显示LMB中的坏死和支气管食管瘘。支气管活检显示典型菌丝伴坏死组织，表明毛霉菌病.开始患者的抗真菌药物（脂质体两性霉素），并要求及时进行手术咨询。病人,然而,死于大咯血.我们描述了一例控制不佳的糖尿病患者的肺部毛霉菌病伴支气管食管瘘的罕见病例。这种组合的稀有性突出了相关的诊断和治疗障碍。及早发现,抗真菌药物,尽快对受累组织进行手术清创，多学科方法可以改善患者预后.
