急性白血病继发热带念珠菌骨髓炎1例并文献复习
Acute Leukemia Complicated with Tropical Candida Osteomyelitis:a Case Report and Literature Review
郑震罡 1刘芳 2孟庆彩 3付建珠 4成志勇 4柳倩 4张娇1
作者信息
- 1. 定州市人民医院感染性疾病科,河北 定州 073000
- 2. 保定市儿童医院病理科,河北 保定 071000
- 3. 保定市第一医院检验科,河北 保定 071000
- 4. 保定市第一医院血液内科,河北 保定 071000
- 折叠
摘要
目的 报告1例急性白血病化疗后伴有严重播散性热带念珠菌血症并侵犯多脏器病例,为进一步治疗侵袭性真菌感染积累临床经验.方法 查阅国内外相关文献,对1例白血病化疗后侵袭性真菌病患者临床诊疗进行回顾性分析.结果 患者男性,59岁,诊断为急性髓系白血病,给予多次大剂量阿糖胞苷化疗后,出现严重骨髓抑制、播散性热带念珠菌血症,导致肋骨骨髓炎及肋软骨炎及胸壁脓肿.经病灶清除术联合两性霉素B+卡泊芬净及氟尿嘧啶治疗后病情稳定.结论 化疗后骨髓抑制期播散性热带念珠菌血症,导致肋(软)骨炎,进一步侵犯周围组织,需要与骨结核、白血病髓外浸润鉴别,同时手术联合足疗程抗真菌治疗才能达到治愈目的.
Abstract
Objective To analyze a case of acute leukemia complicated with severe disseminated tropical candidemia and multiple organ invasion after chemotherapy so as to accumulate clinical experience for invasive fungal infections.Methods Relevant domestic and international literature was reviewed,and a retrospective analysis was conducted of clinical diagnosis and treatment of a patient with invasive fungal disease after leukemia chemotherapy.Results The patient,a 59-year-old male diagnosed with acute myeloid leukemia,developed severe myelosuppression and disseminated tropical candidemia after receiving multiple high-dose cytarabine chemotherapy,resulting in rib osteomyelitis,costochondritis,and chest wall abscess.The patient's condition stabilized after undergoing focal debridement combined with amphotericin B,caspofungin,and fluorouracil treatment.Conclusion Disseminated tropical candidemia during the myelosuppression phase after chemotherapy can lead to costochondritis and further invasion of surrounding tissues,and it is necessary to differentiate this condition from bone tuberculosis and extramedullary infiltration of leukemia;simultaneously,a combination of surgical intervention and adequate antifungal therapy is required to achieve an effective therapeutic effect.
关键词
热带念珠菌/白血病/骨髓炎/真菌血症Key words
tropical candida/leukemia/osteomyelitis/mycosis引用本文复制引用
出版年
2024
NETL
NSTL
万方数据