已阅读5页,还剩13页未读, 继续免费阅读
版权说明:本文档由用户提供并上传,收益归属内容提供方,若内容存在侵权,请进行举报或认领
文档简介
Pulmonary Mucormycosis,History,A 64-year-old woman with a history of mantle cell lymphoma and stem cell transplantation 2.5 years earlier presented with cough and chest pain. She had received voriconazole prophylaxis, and she had cytopenia, recurrent graft-versus-host disease, and diabetes mellitus. Chest computed tomography (CT) was performed to assess the patients cough and chest pain.,The initial CT examination (Figs 1, 2) revealed a rounded consolidation with surrounding ground-glass opacity (GGO) (halo sign) in the anterior segment of the right upper lobe. The second CT examination (Figs 3, 4) revealed that the pulmonary opacity had increased in size and changed in morphology from a halo configuration to a reversed halo configuration (central GGO with surrounding irregular rim of consolidation). In addition, the consolidation and GGO extended to the pleura, resulting in pleural thickening (Figs 3, 4).,1,Initial axial noncontrast chest CT image of the right upper lobe. There is a focal area of consolidation in the anterior segment of the right upper lobe with surrounding GGO.,2,Initial coronal noncontrast chest CT image of the right upper lobe. There is a focal area of consolidation in the anterior segment of the right upper lobe with surrounding GGO.,3,Axial noncontrast chest CT image of the right upper lobe obtained 1 week after Figure 1. The previously demonstrated consolidation has increased in size. There is also new central GGO with a surrounding irregular rim of consolidation (reversed halo sign). In addition, the conglomerate consolidation and GGO have extended to the visceral pleura, resulting in pleural thickening.,4,Coronal noncontrast chest CT image of the right upper lobe obtained 1 week after Figure 2. The previously demonstrated consolidation has increased in size. There is also new central GGO with a surrounding irregular rim of consolidation (reversed halo sign). In addition, the conglomerate consolidation and GGO have extended to the visceral pleura, resulting in pleural thickening.,Partial opacification of the maxillary and ethmoid sinuses was visible on contrast materialenhanced CT images of the head obtained 5 days after the initial chest CT examination was performed 。 Frothy material in the sphenoid sinus was also seen (Fig 6). Subtle contrast enhancement was present along the left medial orbital wall and associated with destruction of the lamina papyracea and extraconal extension of inflammation (Fig 5).,5、6,Discussion,The reversed halo sign was first described in the setting of cryptogenic organizing pneumonia but is not specific to this disease . It also occurs in the setting of paracoccidioidomycosis, lymphomatoid granulomatosis, Wegener granulomatosis, and mucormycosis (25). In this patient, cryptogenic organizing pneumonia was unlikely, given the focality, dramatic growth, and location of the consolidation and GGO. Paracoccidioidomycosis was not considered, as the patient had not traveled to any endemic area (2). Also, lymphomatoid granulomatosis was unlikely because of the absence of the typical radiographic findings of multiple pulmonary nodules along the bronchovas-cular tree (3). Although this patient had upper airway inflammation and pulmonary disease consistent with Wegener granulomatosis, the typical radiographic findings of multiple pulmonary nodules with potential cavitation were not present. Furthermore, this patient did not have nephritis, which is present in over 80% of patients with Wegener granulomatosis (6).,Invasive aspergillosis was the initial consideration in this patient, given the halo sign on the initial CT images. However, the following factors favored a diagnosis of mucormycosis: diabetes, recent prophylaxis with voriconazole, concomitant sinusitis, and the reversed halo sign at follow-up CT,Mucormyocosis is infection by fungi in the class Zygomycetes, most commonly in the order Mucorales. Infection is usually caused by inhalation of spores; therefore, the paranasal sinuses and lungs are most commonly affected (9). Risk factors for infection include diabetes (especially in the setting of diabetic ketoacidosis), hematologic malignancy, stem cell or solid organ transplantation, immunosuppression, graft-versus-host disease, and desferoxamine therapy (10). The majority of these risk factors act by imparing neutrophil function (7).,A high index of suspicion is necessary to diagnose mucormycosis. The clinical presentation varies depending on the site affected. Pulmonary infection causes fever, cough, hemoptysis, and pleuritic chest pain, as in this patient. Sinus infection causes facial pain, anosmia, congestion, epistaxis, or headache (11). On histopathologic examination, Zygomycetes hyphae are broad and irregular with right-angled branching, as opposed to Aspergillus hyphae, which are thinner with more acute-angled branching. There may be pulmonary angioinvasion, vascular thrombosis, or necrosis,Imaging findings are mostly nonspecific and include consolidation, nodules, masses, cavities, lymphadenopathy, and pleural effusion . Findings suggestive of invasive fungal infection include the air crescent sign (a thin rim of air between the necrotic lung and the surrounding parenchyma) and the halo sign (consolidation with a rim of surrounding GGO).,It is important to distinguish mucormycosis from aspergillosis because the treatments can differ and because appropriate early treatment of mucormycosis may improve the outcome (13). Given the high suspicion for mucormycosis, this patient was treated with a broad antifungal agent instead of voriconazole, which is ineffective against mucormycosis. In the appropriate clinical setting (as in this patient), the reversed halo sign is suggestive of mucormycosis (5,14). In eight patients with invasive fungal infection and the reversed halo sign, seven had mucormycosis and one had aspergillosis (5). Multiple pulmonary nodules (10 or more), pleural effusion, development of infection despite voriconazole prophylaxis, and sinusitis favor mucormycosis over aspergillosis (8).,Treament,Treatment for mucormycosis depends on antifungal agents, surgery, and control of predisposing conditions. Amphotericin B and, more recently, posaconazole are efficacious in the treatment of mucormycosis
温馨提示
- 1. 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007和PDF阅读器。图纸软件为CAD,CAXA,PROE,UG,SolidWorks等.压缩文件请下载最新的WinRAR软件解压。
- 2. 本站的文档不包含任何第三方提供的附件图纸等,如果需要附件,请联系上传者。文件的所有权益归上传用户所有。
- 3. 本站RAR压缩包中若带图纸,网页内容里面会有图纸预览,若没有图纸预览就没有图纸。
- 4. 未经权益所有人同意不得将文件中的内容挪作商业或盈利用途。
- 5. 人人文库网仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对用户上传分享的文档内容本身不做任何修改或编辑,并不能对任何下载内容负责。
- 6. 下载文件中如有侵权或不适当内容,请与我们联系,我们立即纠正。
- 7. 本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。
最新文档
- 2024-2030全球与中国化妆品活性成分市场现状及未来发展趋势
- 山西省2024九年级物理全册第十八章电功率专题2.动态电路和极值问题课件新版新人教版
- 2024年南京市高淳县《高等数学(一)》(专升本)模拟预测试卷含解析
- 2024年云南省迪庆藏族自治州德钦县《高等数学(一)》(专升本)考前冲刺试卷含解析
- 2024年东海县《高等数学(一)》(专升本)高分冲刺试卷含解析
- 2022年监理工程师《建设工程质量控制》考前必做题(二)
- 印刷品加工合同
- 购销合同样本(超市作为销售方)
- 域名购买合同
- 我看见了大海作文共九篇
- 篮球直播策划方案
- 2024深圳电工证考题模及答案电工考题(全国通用)
- 人工智能与智能教育的关系
- 化工园区化学事故卫生健康应急救援机构建设指南
- 模型15 十字架模型(学生用)
- 新媒体时代新闻“消费者”角色的新特征
- 服装公司车间工人培训方案
- 社交媒体平台对舆论引导的影响力增强
- 计算机网络课件-谢希仁
- 任务驱动教学法心得与体会范本
- 社区获得性肺炎的诊疗和治疗
评论
0/150
提交评论