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Fatal Cutaneous Mucormycosis After Kidney Transplant

机译:肾脏移植后致命的皮肤毛霉菌病

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Mucormycosis is an uncommon opportunistic infec-tion that is caused by Mucorales from the Zygomycetes class. Patients with severe immuno-deficiency admitted to the hospital are at greatest risk for developing this infection. Mucormycosis usually is transmitted in humans by inhalation or inoculation of spores in the skin or mucous membranes. A 66-year-old man developed a surgical wound infection at 1 week after kidney transplant that did not improve despite broad-spectrum antibiotics and debridement. He was transferred to our hospital 45 days after transplant and had fever and a large purulent wound that was surrounded by a black necrotizing margin. Immunosuppressive drugs were discontinued and the dosage of prednisolone was decreased. Massive debridement was performed but was incomplete because he had full-thickness abdominal wall necrosis. Histopathology showed broad fungal hyphae without septation, consistent with the diagnosis of mucormycosis. Despite antifungal therapy with amphotericin B and additional debridement, the patient died of septic shock at 52 days after kidney transplant. Cutaneous fungal infections should be considered in the differential diagnosis of any nonhealing infected wound that does not respond to broad-spectrum antibiotics, especially in patients with predisposing risk factors such as transplant.
机译:毛霉菌病是一种不常见的机会性感染,是由合子菌类的毛霉菌引起的。住院严重免疫缺陷的患者发生这种感染的风险最大。毛霉菌病通常是通过吸入或接种皮肤或粘膜中的孢子在人类中传播的。一名66岁的男子在肾脏移植后1周出现了手术伤口感染,尽管使用了广谱抗生素和清创术,但仍无改善。移植后45天,他被转移到我们医院,并发烧和化脓性伤口,周围有黑色的坏死边缘。停止使用免疫抑制药物,并降低泼尼松龙的剂量。进行了大面积的清创术,但由于他有全层腹壁坏死而未完成。组织病理学检查显示广泛的真菌菌丝未分离,与毛霉菌病的诊断一致。尽管用两性霉素B进行了抗真菌治疗并进行了更多的清创术,但该患者在肾脏移植后52天死于败血性休克。在任何对广谱抗生素无反应的未愈合感染伤口的鉴别诊断中,应考虑皮肤真菌感染,尤其是在具有易感风险因素(例如移植)的患者中。

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