PDF(Pubmed)
Abstract：
Mucormycosis is an invasive fungal infection that can result in severe lung infections, with pulmonary mucormycosis (PM) being one of the most prevalent manifestations. Prompt diagnosis is crucial for patient survival, as PM often exhibits rapid clinical progression and carries a high fatality rate. Broncho-alveolar lavage fluid or endobronchial biopsy (EBB) has been commonly employed for diagnosing PM, although there is limited mention of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the literature. In this report, we present a case of PM in a patient with diabetes. While EBB did not yield evidence of Rhizopus infection, a definitive diagnosis was obtained through EBUS-TBNA. The patient underwent combination therapy, including oral medication, nebulization, and EBUS-guided intrafocal amphotericin B injection, which resulted in significant improvement following the failure of initial therapy with amphotericin B injection cholesterol sulfate complex. Our case highlights the potential of EBUS-TBNA not only for mediastinal lymphadenopathy but also for obtaining extraluminal lesion specimens. Furthermore, for patients with an inadequate response to mono-therapy and no access to surgical therapy, the addition of EBUS-guided intralesional amphotericin B injection to systemic intravenous therapy may yield unexpected effects.
摘要：
毛霉菌病是一种侵袭性真菌感染，可导致严重的肺部感染，肺毛霉菌病（PM）是最常见的表现之一。及时诊断对患者生存至关重要，因为PM通常表现出快速的临床进展和高病死率。支气管肺泡灌洗液或支气管内活检（EBB）通常用于诊断PM，尽管文献中很少提及支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）。在这份报告中,我们介绍了一例糖尿病患者的PM。虽然EBB没有产生根霉感染的证据，通过EBUS-TBNA获得明确诊断.患者接受了联合治疗，包括口服药物,雾化，和EBUS引导的两性霉素B内注射，在两性霉素B注射硫酸胆固醇复合物的初始治疗失败后，显着改善。我们的病例强调了EBUS-TBNA不仅可以用于纵隔淋巴结病，而且可以用于获得腔外病变标本。此外，对于对单一疗法反应不足且无法获得手术治疗的患者，在全身静脉治疗中加入EBUS引导下的病灶内注射两性霉素B可能产生意想不到的效果.
