伏立康唑不能治疗1例免疫缺陷儿童的播散性接合菌病

作     者：Ritz N. Ammann R.A. Aebischer C.C. C. Aebi 王经纬 

作者机构：Department of Paediatrics University of Bern Inselspital 3010 Bern Switzerland 

出 版 物：《世界核心医学期刊文摘（儿科学分册）》 (Dkgest of the World Latest Medical Information)

年 卷 期：2005年第1卷第9期

页      面：41-41页

学科分类：1002[医学-临床医学] 100202[医学-儿科学] 10[医学] 

主　　题：接合菌病 伏立康唑 免疫缺陷 播散性 两性霉素 真菌感染 伯基特淋巴瘤 持续性发热 左上肺叶 发热性 

摘      要：Voriconazole is increasingly used as a first-line agent for empirical antifungal therapy of prolonged febrile neutropenia in paediatric cancer patients. We describe the case of a 9-yearold patient with stage IV Burkitt lymphoma, who developed pulmonary and splenic zygomycosis while receiving voriconazole for persistent febrile neutropenia. The causative agent, Absidia corymbifera,was identified by broad-range fungalPCR in a lung biopsy sample. The patient was successfully treated with a combination of partial resection of the left upper lobe and antifungal therapy with high-dose liposomal amphotericin B followed by oral itraconazole as demonstrated by resolving pulmonary infiltrates on serial high resolution CT scans. Conclusion: This case emphasises that the lack of in vitro activity of voriconazole against zygomycetes is clinically relevant. Failure of voriconazole in suspected fungal infection should be investigated for the possibility of zygomycosis. Broad-range polymerase chain reaction may be able to identify the causative organism when cultures remain sterile.