摘要 目的：提高对儿童白血病化疗后合并鼻眶脑型毛霉菌感染的认识。方法：回顾分析1例急性B淋巴细胞性白血病（B-ALL）患儿诱导化疗期间合并鼻眶脑型毛霉菌病的临床资料，并复习相关文献。结果：3岁女童，确诊B-ALL，诱导化疗期间反复发热，前后出现眼睑肿胀、鼻出血、上睑下垂、视物不清，行鼻腔镜检查、分泌物培养及头颅核磁增强等检查，诊断为鼻眶脑型毛霉菌病，给予两性霉素B脂质体静点、泊沙康唑口服、两性霉素B鞘内注射抗真菌治疗，感染得到有效控制。结论：毛霉菌是一种条件致病性真菌，多见于免疫力低下的患者，毛霉菌通过鼻腔和呼吸道进入，可侵入鼻窦和眼眶，引起坏死性炎症和肉芽肿；也可直接或经血流侵入脑部，引起颅内感染。本病发病急，病情进展快，诊断困难，死亡率高。以两性霉素B制剂为主导的药物及手术联合治疗有助于改善预后。
Abstract
Abstract: Aim： To improve the understanding of rhino-orbito-cerebral mucormycosis infection after chemotherapy in children with leukemia. Methods： The clinical data of a child with acute B - lymphocytic leukemia (B - ALL) complicated with rhino-orbito-cerebral mucormycosis during induction chemotherapy were retrospectively analyzed, and the related literature was reviewed. Results： A 3- year - old girl was diagnosed with B - ALL. During induction chemotherapy, she had repeated fever, eyelid swelling, nasal bleeding, eyelid ptosis, and blurred vision. She was diagnosed with rhino-orbito-cerebral mucormycosis by nasal endoscopy and airway secretion culture and cranial enhanced MRI, and was given amphotericin B liposome IV drip, posaconazole oral administration, and amphotericin B intrathecal injection to used for fungal therapy. The infection was effectively controlled. Conclusion： Mucor is a kind of conditioned pathogenic fungi, which is more common in patients with low immunity. Mucor enters human body through nasal cavity and respiratory tract, which can invade paransal sinus and orbits, causing necrotizing inflammation and granuloma. It can also invade the brain directly or through the bloodstream, causing intracranial infection. The onset and the progression of mucormycosis is quickly, but the diagnosis is difficult, and it has a high mortality rate. Combined treatment with amphotericin B as the main drug and surgery can improve the prognosis.
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