Fatal Cutaneous Mucormycosis After Kidney Transplant
Fatal Cutaneous Mucormycosis After Kidney Transplant
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DOI：
10.6002/ect.2013.0216
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发表时间：
2015-02-01
影响因子：
0.9
通讯作者：
Fazli, Jafar Taghizade
中科院分区：
文献类型：
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作者：
Davuodi, Setareh;Manshadi, Seyed Ali Dehghan;Fazli, Jafar Taghizade
毛霉菌病是一种罕见的机会性感染，由接合菌纲毛霉菌引起。入院的患有严重免疫缺陷的患者发生这种感染的风险最大。毛霉菌病通常通过吸入或接种皮肤或粘膜中的孢子在人类中传播。一名 66 岁男性在肾移植后 1 周出现手术伤口感染，尽管使用广谱抗生素和清创术，但仍没有改善。移植后 45 天，他被转入我们医院，出现发烧和大面积化脓伤口，周围有黑色坏死边缘。停用免疫抑制药物并减少泼尼松龙的剂量。进行了大规模清创，但并不彻底，因为他的腹壁全层坏死。组织病理学显示广泛的真菌菌丝，无分隔，与毛霉菌病的诊断一致。尽管使用两性霉素 B 进行抗真菌治疗并进行额外清创，患者仍于肾移植后 52 天死于败血性休克。在任何对广谱抗生素无反应的不愈合感染伤口的鉴别诊断中，应考虑皮肤真菌感染，特别是对于具有移植等诱发危险因素的患者。
Mucormycosis is an uncommon opportunistic infection that is caused by Mucorales from the Zygomycetes class. Patients with severe immunodeficiency admitted to the hospital are at greatest risk for developing this infection. Mucormycosis usually is transmitted in humans by inhalation or inoculation of spores in the skin or mucous membranes.A 66-year-old man developed a surgical wound infection at 1 week after kidney transplant that did not improve despite broad-spectrum antibiotics and debridement. He was transferred to our hospital 45 days after transplant and had fever and a large purulent wound that was surrounded by a black necrotizing margin. Immunosuppressive drugs were discontinued and the dosage of prednisolone was decreased. Massive debridement was performed but was incomplete because he had full-thickness abdominal wall necrosis. Histopathology showed broad fungal hyphae without septation, consistent with the diagnosis of mucormycosis. Despite antifungal therapy with amphotericin B and additional debridement, the patient died of septic shock at 52 days after kidney transplant.Cutaneous fungal infections should be considered in the differential diagnosis of any nonhealing infected wound that does not respond to broad-spectrum antibiotics, especially in patients with predisposing risk factors such as transplant.