儿童急性淋巴细胞白血病合并真菌性食管炎3例临床分析

Clinical analysis of three cases of fungal esophagitis in children with acute lymphoblastic leukemia

目的总结急性淋巴细胞白血病（ALL）患儿合并真菌性食管炎的诊断与治疗经验。方法回顾分析3例ALL患儿于化疗过程中合并真菌性食管炎的临床特点及诊治经过,与同期住院的ALL不同部位感染作比较。结果 3例ALL患儿于化疗期间和化疗后出现上腹痛、呕吐或心前区不适,经胃镜检查诊断为真菌性食管炎。1例患儿伴发热和粒细胞缺乏,3例患儿均接受包含地塞米松的化疗。3例患儿分别经氟康唑、米卡芬净、伊曲康唑治疗2～4周,胃镜复查均治愈。结论 ALL患儿化疗过程中出现上腹部疼痛或心前区不适等症状时应考虑行胃镜检查以及时发现真菌性食管炎,胃镜检查可作为粒细胞缺乏伴感染时寻找真菌感染的手段,真菌性食管炎的治疗效果佳。

Objective To summarize how to diagnose and manage fungal esophagitis in children with acute lymphoblastic leukemia（ALL）.Methods Retrospectively reviewed the clinical manifestations,diagnosis and treatment of fungal esophagitis in three children with acute lymphoblastic leukemia during chemotherapy.Comparing to different sites of infections for ALL patients at the same period,the approximate incidence of fungal esophagitis was during chemotherapy.Results Three patients with ALL who had epigastric pain,vomiting or discomfort of the precordial area during and after chemotherapy.All cases were diagnosed fungal esophagitis through gastroscopy.One case had fever and neutropenia.The regimen for chemotherapy in all patients included dexamathasone.Three patients were given fluconazole,micafungin and itraconazole respectively for two to four weeks.They all recovered based on gastroscopy results.Conclusions Gastroscopy can be considered to perform in order to make sure of fungal esophagitis when ALL patients have symptoms of epigastric pain or discomfort of the precordial during chemotherapy.Gastroscopy can be a useful way to find out the site of fungal infection when patient is febrile and neutropenic.Antifungal drugs are effective for fungal esophagitis.