造血干细胞移植术后继发外生殖器黄曲霉感染一例

A case of genital aspergillosis following allogeneic hematopoietic stem cell transplant

目的报告一例外生殖器黄曲霉感染。方法对患者的临床资料、真菌学检查、胸部CT检查结果进行分析。结果患者男,33岁,5个月前确诊为急性髓性白血病M_1型,经化疗诱导缓解后接受异基因造血干细胞移植术。术后7天患者出现发热,38～38.5℃,多种抗生素治疗无效。同时外生殖器部位出现多个圆形水肿性红斑,直径0.2～1 cm,中央覆盖黑色焦痂。龟头冠状沟可见糜烂及坏死性皮疹。取皮损渗出物及痂皮作常规真菌检查,分离出黄曲霉。静脉滴注伊曲康唑、局部外用碘伏溶液33天后皮疹治愈。移植术后第137天,胸部CT检查显示右上肺尖一薄壁空洞。结论该患者为造血干细胞移植术后继发外生殖器黄曲霉感染,感染源可能与肺部病灶有关。

Objective To report a case of genital aspergillosis. Methods The clinical data, results of fungal examination and of computed tomography （ CT ） of chest were analyzed for this patient. Results A 33-year-old male patient with acute myelogenous leukemia underwent allogeneic hematopoietic stem cell transplant after relief induced by chemotherapy. Seven days after the transplant, he developed a persistent fever ranging between 38 ℃and 38.5 ℃, which did not respond to daily treatment with multiple antibiotics. Meanwhile, several eruptions appeared on the genitals. Physical examination revealed multiple round, well-circumscribed, edematous and erythematous lesions measuring 0.2 - 1 cm in diameter with black eschar in their center on the scrotum and glans. Erosion and necrosis were also seen on the coronary sulcus. Aspergillus flavus was isolated fi＇om exudation and crust of the lesions. The infection was successfully treated by intravenous itraconazole and topical iodine solution for 33 days. One hundred and thirty-seven days after the transplant, CT of the chest revealed a cavitary lesion on the right upper lung, measuring 16.6 mm × 15.2 mm, strongly suggesting a chronic fungal infection. Conclusion A case of genital aspergillosis, likely to be caused by hematogenous spread from pulmonary lesion following allogeneic hematopoietic stem cell transplantation, is reported here.