黄曲霉致鼻-眼-耳-脑侵袭性曲霉病的抗真菌治疗

Antifungal therapy in severe rhinosino-optical-otic and cerebral invasive aspergillosis caused by Aspergillus flavus

报告1例抗真菌治疗有效的重症鼻、眼、耳、脑侵袭性曲霉病。患者男,37岁,因右眼眶肿物11a,右眼视力下降8a,失明伴头痛、头晕进行性加重1a就诊。11a前曾行右上颌窦根治术。临床表现为右眼球突出眼眶,角膜混浊,球结膜充血,眼球内可见白色絮状团块,并有大量透亮稀薄液态分泌物流出。右眼球不能自主活动,完全无光感。右眼眶下方、右上颌窦骨质缺损,塌陷。右侧外耳道骨壁、乳突均受累及。右侧鼻道及外耳道亦见较多透亮稀薄液态分泌物。右眼、右鼻腔、右耳分泌物真菌涂片均见菌丝及孢子,培养结果均为同一黄曲霉。经两性霉素B及伊曲康唑、氟胞嘧啶联合抗真菌治疗6周后,予口服伊曲康唑维持治疗近18个月,目前病变区显著缩小,头痛、头晕症状消失。

A case of one 37-year-old male who suffered from severe rhinal-optical-otic and cerebral invasive aspergillosis caused by Aspergillus flavus is reported. Since a surgical procedure in the fight maxillary sinus in 1995, the patient had experienced ipsilateral recurrent orbital granuloma, for 11 years, followed with descended right visual acuity for 8 years, and eyesight loss with progressive headache, dizziness for 1 year. As presented, right eyeball is out of the fossa orbitalis, with cloudy cornea, and bloody bulbar conjunctiva. White floccular clumping can be found in his fight eyeball ,from where massive lucent secretion flowed. The right eyeball loss its moving ability and light perception. Bones below the right fossa boritalis and the maxillary sinus were destructed, as well as right external acoustic meatus and mastoid process. Filament and spore were found in the secretion from right eye, right nasal cavity and right ear, which was identified as Aspergillusflavus. Extend of pathological changes contracted evidently after 6-week antifungal treatment combined with amphotericin B,itraconazole and fluconazole, followed with 18-month oral itraconazole.