烟曲霉菌致深部软组织急性化脓性感染诱发糖尿病酮症酸中毒一例

A case of diabetic ketoacidosis induced by acute suppurative infection of deep soft tissue caused by Aspergillus fumigatus

目的探讨烟曲霉菌致皮肤软组织感染诱发糖尿病酮症酸中毒的临床特点、诊断和治疗。方法分析2022年1月23日六安市中医院收治1例以皮肤软组织曲霉菌感染为首发表现的糖尿病酮症酸中毒患者住院资料,对该病的临床特点、危险因素、诊断以及治疗进行探讨。结果患者男性、29岁,既往无糖尿病史,以背部软组织化脓性感染为首发症状,入院相关检查诊断糖尿病酮症酸中毒,初始予哌拉西林他唑巴坦(4.5 g/次、静脉滴注、1次/8 h,疗程:21 d)抗感染治疗。患者脓性分泌物3 d后报阳(烟曲霉菌),予伏立康唑(200 mg/次、静脉滴注、1次/12 h、首日加倍、疗程:19 d)抗真菌治疗。经过骨科会诊后行胸背部脓肿切开病灶清除术,组织病理示:大量肉芽组织伴坏死。术中脓性组织微生物培养3 d后报阳(烟曲霉菌)。经过哌拉西林他唑巴坦(4.5 g/次、静脉滴注、1次/8 h、疗程:21 d)+伏立康唑(200 mg/次、静脉滴注、1次/12 h、疗程:19 d)抗感染治疗后患者脓性病灶逐渐缩小,顺利出院。结论曲霉菌导致的深部软组织化脓性感染临床表现无特异性,诱发糖尿病酮症酸中毒更为罕见。对基础有免疫功能紊乱的患者合并软组织感染,需结合分子生物学和微生物培养考虑真菌感染可能,早期诊断和治疗,改善预后。

Objective To investigate the clinical characteristics,diagnosis and treatment of diabetic ketoacidosis(DKA)induced by skin soft tissue infection caused by Aspergillus fumigatus.Methods The clinical features,risk factors,diagnosis and treatment of a patient with DKA and Aspergillus fumigatus infection of skin and soft tissue as the first manifestation were analyzed in January 2022 in Traditional Chinese Hospital of Lu’an.Results The patient,a 29-year-old male without history of diabetes,presented with a suppurative infection of the soft tissues of the back as the first manifestation.The patient was diagnosed as DKA by relevant examination on admission and received initial anti-infection treatment with piperacillin and tazobactam(4.5 g/time,intravenous infusion,once/8 h,course of treatment:21 days).The patient’s purulent secretions were cultured for 3 days,suggesting Aspergillus fumigatus and was given antifungal therapy with voriconazole(200 mg/time,intravenous infusion,once/12 h,doubled on the first day,course of treatment:19 days).After orthopedic consultation,the focus removal was performed.The histopathology showed that there were a lot of granulation tissue with necrosis.During the operation,the purulent tissue was cultured for 3 days and reported positive(Aspergillus fumigatus).After anti-infective treatment,the patient’s purulent lesion gradually shrank and was discharged successfully.During the operation,the purulent tissue was cultured for 3 days,which suggested Aspergillus fumigatus.After anti-infection treatment with piperacillin and tazobactam(4.5 g/time,intravenous infusion,once/8 h,course of treatment:21 days)+voriconazole(200 mg/time,intravenous infusion,once/12 h,course of treatment:19 days),the patient was discharged successfully.Conclusions The suppurative infection of deep soft tissue caused by Aspergillus fumigatus is rarely reported,the clinical manifestations are not specific,and DKA is rare.For patients with underlying immune dysfunction complicated with soft tissue infection,the possibility of fungal infection should be considered combined with molecular biology and microbial culture,and early diagnosis and treatment should be considered to improve the prognosis.