卡泊芬净治愈肝豆状核变性合并奥默毕赤酵母菌感染1例并文献复习

A case of patient with pichia ohmeri fungemia associated with HLD successfully treated with caspofungin and a literature review

1例确诊为奥默毕赤(柯达)真菌血症的患者,经卡泊芬净治疗后痊愈。该患者因双下肢瘀点,外院诊断"过敏性紫癜,溶血性贫血,肾炎,肝功能损害等。给予激素治疗1月余,瘀点消失,但因肺部感染,反复发热,外院给予多种抗细菌药物治疗,疗效一般,确诊为肝豆状核变性转诊我院。入院后体温升高,血培养检查提示为奥默毕赤酵母菌感染,给予氟康唑100 mg静脉点滴,2次/d,治疗2周无效。后给予卡泊芬净50 mg静脉点滴,1次/d,治疗32天,体温逐渐正常,后多次血培养阴性,考虑真菌血症治愈。肝豆状核变性患者免疫功能较低,容易合并感染。为避免复发,抗真菌药物治疗应在血培养阴性,体温正常后持续2周以上。

A case of patient diagnosed as pichia( kodamaea) ohmeri fungemia was recovered by treatment of caspofungin. This patient was once diagnosed as anaphylactoid purpura,hemolytic anemia,nephritis,or liver function damage on the basis of petechiae on his bilateral lower limbs. In the past month,the patient was given hormone therapy and all petechiae disappeared in another hospital,but because of respiratory infection and recurrent fever,he continuously took various antibacterial drugs till being transfered to our hospital on the new diagnosis of hepatolenticular degeneration( HLD). After admission,the history of prolonged fever and results of blood culture showed that there existed an infection of pichia ohmeri. The patient then received treatment with intravenous fluconazole 100 mg twice a day for two weeks without corroborating clinical efficacy. And after the therapy of intravenous caspofungin 50 mg once a day for 32 days,we considered that fungemia in this patient was indeed cured when his body temperature gradually dropped to normal and the blood cultures consecutively got negative results. The HLD patients commonly have lower immunologic function and are often easily complicated with various infections,so the anti-fungal treatment should be sustained for more than 2 weeks after negative blood culture and body temperature recovery so as to avoid the recurrence of pichia ohmeri fungemia.