气道受累的侵袭性毛霉病一例并文献复习

Endobronchial Mucormycosis: A Case Report and Literature Review

目的通过报道1例气道受累的侵袭性毛霉病病例及文献复习总结该类疾病的诊治经验。方法报道我院收治的1例以气道受累为突出表现的毛霉病患者的临床资料。检索Pubmed、万方和CNKI数据库,将24例类似病例进行汇总分析。结果患者39岁,男性,咳嗽、咳痰2月,发热1个月。既往有糖尿病。CT示右上叶支气管狭窄伴周围实变。支气管镜下见右上叶支气管开口息肉样新生物阻塞。超声内镜下经支气管针吸活检确诊毛霉病。予右肺上叶切除及静点两性霉素B治疗,患者痊愈。总结24例以气道受累为主的毛霉病病例,75%合并有糖尿病。常见症状为咳嗽、咳痰、发热、咯血和憋气。支气管镜下均可见明显的黏膜改变,59.1%见管腔内新生物阻塞。经支气管镜活检确诊率为95.5%。可采取注射两性霉素B联合支气管镜下介入治疗。手术切除病灶可以减少致命性大咯血的发生。结论气道受累是肺毛霉病的一种特殊类型,多见于糖尿病患者,患者有大咯血的风险。支气管镜检查有助于尽早确诊并选择恰当的治疗。

Objective To describe the clinical feature of endobronchial mucormycosis,improve the knowledge of endobronchial mucormycosis. Methods One case of endobronchial mucormycosis was described and 24 similar cases reported detailedly were reviewed. Results A 39-year-old male with poorly controlled diabetic mellitus presented cough,sputum and fever. The CT scans showed opacities in right upper lobe. Bronchoscopy reviewed polypoid mass obstructing the right upper lobe orifice. Mucormycosis was diagnosed by endobrongchial ultrasound transbronchial needle aspiration biopsy. This patient was treated with right upper lobe resection combined with intravenous Amphotericin B and survived. 75% of patients among the total 24 cases of endobronchial mucormycosis were diabetics. The most common symptoms were cough,sputum,fever,hemoptysis and dyspnea. Bronchoscopy revealed bronchial mucosal lesions. In 59. 1% of cases,endobronchial mass were found. Diagnosis was made in 95. 5% of cases by biopsy through bronchoscopy. Intravenous Amphotericin B combined with interventional bronchoscopy could be chosen.Lobectomy could prevent against fatal hemoptysis. Conclusions Endobronchial mucormycosis is a special subtype of pulmonary mucormycosis. The patients usually have diabetes mellitus and high risk of hemoptysis.Bronchoscopy contributes to the early diagnosis and determination of further treatment.