1例两性霉素B脂质体联合泊沙康唑治疗儿童糖尿病合并肺毛霉菌病并文献复习

Efficacy and safety of liposomal amphotericin B combined with posaconazole in treatment of diabetes mellitus with pulmonary mucormycosis in children:a case report and literature review

目的:探索两性霉素B脂质体联合泊沙康唑治疗儿童糖尿病合并肺毛霉菌病的有效性和安全性。方法:回顾性分析1例儿童糖尿病合并肺毛霉菌病患者应用两性霉素B脂质体联合泊沙康唑治疗过程并文献复习。结果:支气管镜下发现左肺上叶段支气管痰栓堵塞和肉芽增生,支气管肺泡灌洗液涂片见毛霉菌,诊断肺毛霉菌病。予两性霉素B脂质体静脉治疗1周后复查胸部CT发现左上肺空洞样改变,加用泊沙康唑口服。两性霉素B治疗3周时患者出现窦性心动过缓伴室性早搏,停两性霉素B脂质体后好转。改为泊沙康唑序贯治疗至12周,患者左上肺空洞消失且未出现不良反应。结论:儿童糖尿病合并肺毛霉菌病少见且治疗困难,两性霉素B脂质体联合泊沙康唑治疗方案为临床治疗提供诊疗经验。

Objective:To explore the efficacy and safety of liposomal amphotericin B combined with posaconazole in the treatment of diabetes mellitus with pulmonary mucormycosis in children.Methods:A retrospective analysis was performed on the treatment of a child with diabetes mellitus and pulmonary mucormycosis by liposomal amphotericin B combined with posaconazole,and the relevant literature was reviewed.Results:Sputum bolt occlusion and granulomatous hyperplasia were found in the segmental bronchi of the left upper lobe,and mucorales were found in bronchoalveolar lavage fluid,so a diagnosis of pulmonary mucormycosis was made.After intravenous administration of liposomal amphotericin B for 1 week,a chest CT re-examination revealed cavity-like changes in the left upper lung,and oral posaconazole was added.At 3 weeks of administration of liposomal amphotericin B,the patient developed sinus bradycardia with premature ventricular beats,which improved after discontinuation of liposomal amphotericin B.The medication was changed to sequential administration of posaconazole up to the 12th week,and the cavities in the left upper lung disappeared without any adverse reaction observed.Conclusions:Diabetes mellitus with pulmonary mucormycosis in children are rare and difficult to treat.The regimen of liposomal amphotericin B combined with posaconazole provides some reference for the clinical diagnosis and treatment of the condition.