目的:慢性侵袭性真菌性鼻窦炎继发于惰性毛霉菌病是一种罕见的临床实体,理想的管理是有争议的。本文报道了一例通过保守性清创术和球后两性霉素B成功治疗的惰性毛霉菌病。
方法:一名42岁的患有糖尿病和肾移植的男性患者,表现为慢性侵袭性真菌性鼻窦炎,左眶受累于惰性毛霉菌病。患者接受了积极的全身抗真菌治疗,左球后注射两性霉素B脂质体,减少免疫抑制,保守性手术清创术。尽管涉及到左嗅裂,由于接种颅内间隙的风险,筛板未被切除.鉴于轻微的轨道受累,未进行眼眶清创术,患者在全身和球后两性霉素B的眼眶发现得到解决。患者在6个月随访时具有临床和影像学稳定性.
结论:保守切除并随后长期抗真菌治疗可能是治疗惰性毛霉菌病的成功方案。球后两性霉素B可能是惰性毛霉菌病的谨慎的保留轨道辅助治疗。
OBJECTIVE: Chronic invasive fungal sinusitis secondary to indolent mucormycosis is a rare clinical entity, and the ideal management is controversial. A case of indolent mucormycosis successfully managed with conservative debridement and retrobulbar amphotericin B is herein reported.
METHODS: A 42-year-old man with diabetes mellitus and kidney transplant presented with chronic invasive fungal sinusitis with left orbital involvement from indolent mucormycosis. The patient was treated with aggressive systemic antifungal therapy, left retrobulbar injection of liposomal amphotericin B, reduction in immunosuppression, and conservative surgical debridement. Although the left olfactory cleft was involved, the cribriform plate was not resected due to risk of seeding the intracranial space. Given mild orbital involvement, no orbital debridement was performed and the patient had resolution of his orbital findings with systemic and retrobulbar amphotericin B. The patient had clinical and radiographic stability at 6-month follow-up.
CONCLUSIONS: Conservative resection with subsequent long-term antifungal treatment can be a successful regimen in indolent mucormycosis. Retrobulbar amphotericin B may be a prudent orbit-sparing adjuvant therapy in indolent mucormycosis.