侵袭性深部酵母菌感染致溶骨性破坏

Osteolytic lesion by progressive systemic yeast fungus infection

报告我科近期收治1例侵袭性深部酵母菌感染引起溶骨性破坏的病例。初病时曾怀疑肺结核、肺癌骨转移,后骨髓、血及皮下脓肿穿刺液均培养出同一种酵母菌,同时发现全身多处骨质破坏。结合复习文献探讨了真菌感染致溶骨性损害以马尔尼菲青霉菌感染引起多见,由于临床无特征性,常易误诊。确诊需作真菌培养。此真菌特征为温度双相性,可产生红色色素。两性霉素B脂质体及伊曲康唑治疗有效。

One case of osteolyilc lesion caused by progressive systemic yeast fungus infection was reported in the study. Differential diagnoses of pulmonary tuberculosis, and lung carcinoma with osseous metastasis were considered. Mycological culture of bone marrow, peripheral blood and pucture fluid of subcutaneous abscess confirmed the diagnosis of the same yeast fungus infection. The paper conducted literature review in the study area and explored the most likely infection by penicillium marneffei that might cause osteolytic damages. Since there was no specific clinical manifestation for penicillium marneffer infection, it has been often misdiagnosed. The confirmation of the diagnosis of the disease requires culture of pathogenic fungus from clinical specimens. The fungus is thermally dimorphic and produces red pigment. Amphotericin B liposome and itraconazole are effective in treating penicilliosis marneffei.