多发性骨髓瘤并发上消化道侵袭性念珠菌病2例报道及文献复习

Multiple myeloma complicated with upper gastrointestinal invasive candidiasis:two case reports and literature review

目的探讨多发性骨髓瘤(Multiple myeloma,MM)并发上消化道侵袭性念珠菌病的临床特点,提高诊治该病的水平。方法回顾分析我科2例多发性骨髓瘤并发上消化道侵袭性念珠菌病的诊治过程,分析、总结治疗经验,并结合文献复习骨髓瘤并发上消化道侵袭性念珠菌感染的易感因素、临床表现、诊断和鉴别诊断及治疗。结果 MM患者1,女性,异基因造血干细胞移植术后4个月发生腹泻伴腹部隐痛,抗移植物抗宿主病(graftversus host disease,GVHD)治疗无效,经胃镜诊断上消化道念珠菌病,予卡泊芬净治愈出院。MM患者2,男性,化疗过程中疾病进展,并出现腹胀、腹痛,对症处理改善,再次化疗时上述症状加重并发肺部念珠菌病,发生急性心、肾功能不全,经胃镜诊断上消化道念珠菌病,予伊曲康唑、米卡芬净治疗,最终因肺部真菌感染加重,治疗无效死亡。结论多发性骨髓瘤并发上消化道侵袭性念珠菌病易发生误诊、漏诊。临床医生需提高对该病的认识,首选电子胃镜明确诊断、判断疗效。

Objective To discuss the clinical features of multiple myeloma who complicated with upper gastrointestinal invasive candidiasis, and improve our knowledge about this disease. Methods We retrospectively analysed two patients with multiple myeloma complicated with upper gastrointestinal invasive candidiasis, and reviewed literature about this disease to understanding it＇s risk factors, clinical fature, diagnosis, differential diagnosis and therapy. Result Case 1 A woman was diagnosed a κ light chain multiple myeloma for which she successfully underwent allo-bone marrow transplant. 4 months later she developed diarrhea and pain of belly, anti GVHD treatment was inefficiency. By electronic gastroscopy she was diagnosed upper gastrointestinal invasive candidiasis, and was cured by infusing caspofungin. Case 2 A man was diagnosed an IgG λ multiple myeloma for which he unsuccessfully underwent chemotherapy. With progression of the disease, he developmented abdominal distension,belly pain, heart failure, renal failure as well as pulmonary candidiasis. By electronic gastroscopy he was diagnose upper gastrointestinal invasive candidiasis.Treating with itraconazole and caspofungin were futility, and soonly died of multi-organic failure and cadidiasis infection. Conclusion We explored the clinical features of the disease and found it＇s prone to misdiagnosis. Clinician need enhance the knowledge of the disease, and electronic gastroscopy is essential for diagnosis as well as assessment of treatment effect.