念珠菌属引起肛周阴囊部坏死性筋膜炎合并化脓性肌炎1例

Perianal scrotal necrotizing fasciitis combined with pyomyositis caused by Candida spp.:a case report

患者男性,42岁,既往有乙型病毒性肝炎与膜性肾病病史,入院12 d前间断发热、寒战,入院近2 d加重伴左侧阴囊及会阴部红肿疼痛,立即给予手术清创,患者持续低热,血培养及脓液培养结果为近平滑念珠菌,确诊为真菌类坏死性筋膜炎及化脓性肌炎,选用棘白菌素类米卡芬净(150 mg,qd)抗真菌感染治疗,期间给予蚕食换药、高压氧疗、营养支持等,术后2个月患者病情好转出院。念珠菌属感染引起的坏死性筋膜炎及化脓性肌炎早期临床症状均缺乏特异性,易延误病情,对于合并免疫疾病的患者应注意复杂感染的预防和早期治疗,前期恰当的经验性选用抗真菌药物具有重要的临床意义。

The patient,a 42-year-old male,with a history of hepatitis B and membranous nephropathy,had intermittent fever and chills 12 days before admission.In the first 2 days after admission,the patient’s condition aggravated with redness,swelling and pain in the left scrotum and perineum.Immediate surgical debridement was performed.The patient had a persistent low fever,with blood and pus cultures showing Candida albicans positive,thus was diagnosed fungal necrotizing fasciitis and pyomyositis.The patient was treated with echinocandins mica-fungin(150 mg,qd)for antifungal infection,and was given encroaching dressing change,hyperbaric oxygen therapy,nutritional support,etc.Two months after surgery,the patient’s condition improved and he was discharged.The early clinical symptoms of necrotizing fasciitis and pyomyositis caused by Streptococcus spp.infection lack specificity,thus are prone to be delayed.For patients with concomitant immune diseases,attention should be paid to the prevention and early treatment of complex infection.The appropriate selection of empirical antifungal agents at the early stage has clinical significance.