急性白血病并发慢性播散性念珠菌病二例

Chronic disseminated candidiasis in two patients with acute leukemia

报道2例中性粒细胞减少的白血病患者并发慢性播散性念珠菌病.1例左下肢皮肤溃疡伴持续发热.CT检查：脾多发低密度影和肺结节状斑片影,予皮肤溃疡组织行真菌培养,发现热带念珠菌.另1例伴高热、腹痛,血培养结果示热带念珠菌,CT检查：肝脾肾多发低密度影,肺部多发结节.给予2例患者伏立康唑和卡泊芬净抗真菌治疗,取得良好疗效.发生慢性播散性念珠菌病的高危因素包括持续中性粒细胞缺乏以及预防性使用抗生素.需结合临床表现、微生物学、组织病理学和影像学检查综合诊断.

Two cases of neutropenic leukemia complicated by chronic disseminated candidiasis （CDC）are reported. One patient suffered from cutaneous ulcer on the left thigh with persistent fever; computed tomography scan showed multiple hypodense lesions in the spleen and nodular patchy shadow in the right lung,fungal culture of the dermal ulcer grew Candida tropicalis. Another patient had fever and bellyache, and fungal blood culture grew Candida tropicalis; computed tomography scan showed multiple hypodense lesions in the liver, spleen, kidney and multiple nodules in lungs. A satisfactory outcome was achieved in both patients after treatment with voriconazole and caspofungin. High risk factors of CDC include persistent neutropenia and preventive administration of antibiotics. A synthetic judgment based on clinical manifestations, microbiological examinations, tissue pathology and imaging findings is recommended for the diagnosis of CDC.