急性髓系白血病化疗术后并发肌肉毛霉感染1例

A case of acute myeloid leukemia complicated with muscle mucormycosis after chemotherapy

报道1例47岁男性急性髓系白血病(AML)患者,化疗期间予其行PICC置管后,患者表现为高热、右上侧胸痛、右手腕部肿胀疼痛,12 d内右前臂肌肉组织肿胀面积逐步扩大,伴右手拇指、食指肿胀及麻木。先后给予多种抗生素治疗,效果欠佳,持续高热。通过宏基因组测序(mNGS)技术快速准确辅助临床检测患者外周血、肌肉组织及痰液样本,确诊患者感染的病原体为微小根毛霉,先后予两性霉素B、安必素、泊沙康唑药物对患者进行治疗,感染得到控制。

A 47-year-old male was admitted to hospital with acute myeloid leukemia(AML).During chemotherapy he had high fever,upper right chest pain,swelling and pain of the right wrist after giving a PICC placement.During 12 days,the swelling area of the right forearm muscle tissue gradually expanded,accompanied by swelling and numbness of the right thumb and index finger.A variety of antibiotics were given successively,but the therapeutic effect failed to improve,and the high fever continued.The blood,muscle tissue and sputum samples were examined using metagenomic next-generation sequencing(mNGS).The mNGS assay revealed the pathogen presence of Rhizomucor pusillus.Once targeted antibiotic therapy with amphotericin B,liposomal amphotericin B(AmBisome),and posaconazole were administered,the infection was controlled.