背景:分离的气管支气管毛霉菌病(ITBM)是一种罕见的报道实体。在这里,我们报告了一例2019年冠状病毒病(COVID-19)后的ITBM病例,并对文献进行了系统回顾。
■一位糖尿病控制不佳的45岁绅士出现咳嗽,斑纹咯血,轻度COVID-19疾病后2周,声音嘶哑。计算机断层扫描和柔性支气管镜检查表明存在气管肿块,这是自发的咳痰。肿块的组织病理学检查证实侵入性ITBM。患者在血糖控制下具有完整的临床和放射学分辨率,泊沙康唑,并吸入两性霉素B(8周)。我们对文献的系统回顾确定了另外25例孤立的气道侵袭性毛霉菌病。26名受试者(58.3%为男性)的中位年龄为46岁。糖尿病(79.2%)是最常见的危险因素。不常见的情况,如吻合部位毛霉菌病(在两名肺移植受者中),病毒性疾病后(COVID-19后[n=3],和流感[n=1]),和插管后毛霉菌病(n=1)在少数。三名患者在治疗开始前死亡。大多数患者使用全身抗真菌药(通常是两性霉素B)。在一些患者中进行了两性霉素B的吸入(5/26;19.2%)或支气管镜滴注(1/26;3.8%)和手术(6/26;23.1%)。病死率为50%,主要归因于大咯血。
结论:孤立的气管支气管毛霉菌病是一种罕见的疾病。支气管镜检查有助于早期诊断。由于手术可能不可行,因此需要使用抗真菌药物进行管理并控制危险因素。
BACKGROUND: Isolated tracheobronchial mucormycosis (ITBM) is an uncommonly reported entity. Herein, we report a case of ITBM following coronavirus disease 2019 (COVID-19) and perform a systematic
review of the literature.
UNASSIGNED: A 45-year-old gentleman with poorly controlled diabetes mellitus presented with cough, streaky haemoptysis, and hoarseness of voice 2 weeks after mild COVID-19 illness. Computed tomography and flexible bronchoscopy suggested the presence of a tracheal mass, which was spontaneously expectorated. Histopathological examination of the mass confirmed invasive ITBM. The patient had complete clinical and radiological resolution with glycaemic control, posaconazole, and inhaled amphotericin B (8 weeks). Our systematic
review of the literature identified 25 additional cases of isolated airway invasive mucormycosis. The median age of the 26 subjects (58.3% men) was 46 years. Diabetes mellitus (79.2%) was the most common risk factor. Uncommon conditions such as anastomosis site mucormycosis (in two lung transplant recipients), post-viral illness (post-COVID-19 [n = 3], and influenza [n = 1]), and post-intubation mucormycosis (n = 1) were noted in a few. Three patients died before treatment initiation. Systemic antifungals were used in most patients (commonly amphotericin B). Inhalation (5/26; 19.2%) or bronchoscopic instillation (1/26; 3.8%) of amphotericin B and surgery (6/26; 23.1%) were performed in some patients. The case-fatality rate was 50%, primarily attributed to massive haemoptysis.
CONCLUSIONS: Isolated tracheobronchial mucormycosis is a rare disease. Bronchoscopy helps in early diagnosis. Management with antifungals and control of risk factors is required since surgery may not be feasible.