鼻脑型毛霉菌病临床与病理研究

The clinical and pathological features of rhinocerebral mucormycosis

目的 研究鼻脑型毛霉菌病的临床与病理特点。方法 总结 3例鼻脑型毛霉菌病的临床表现 ,通过尸体解剖或活检作病理检查探讨其特点。结果 3例毛霉菌病均伴有糖尿病酮症酸中毒 ,早期症状常为发热、眶周及颞部疼痛 ,逐渐出现眶尖综合征表现 ,眶周皮肤蜂窝织炎并出血坏死 ,鼻腔黑痂 ,可有脑膜刺激征和偏瘫。额叶等部位出血性坏死 ,镜下可见鼻窦黏膜表面、眼眶及脑内坏死组织有大量毛霉菌。结论 鼻脑毛霉菌好发于糖尿病酮症酸中毒患者 ,病变累及鼻脑和眼部 。

Objective To investigate the clinical and pathological features of rhinocerebral mucormycosis. Methods The clinical data of three cases of mucormycosis were collected and analyzed. Pathological examination was conducted by autopsy or biopsy. Results All the three cases of mucormycosis had diabetic ketoacidosis. The early symptoms were fever, periocular and temporal headache. Gradually, obital apex syndrome, periocular skin cellulitis and necrosis developed. Examination of nose revealed black necrotic turbinates. Meningeal signs and hemiplegia may also occur. Frontal hemorrhagic infaction was seen in pathology. A large amount of mucor fungi were found in the mucosa of nasal sinuses necrotic brain tissue under microscope. Conclusions Rhinocerebral mucormycosis is a rare complication which was mainly seen in patients with diabetic ketoacidosis. The lesion invaded nose, eyes and brain with a high mortality.