面部毛霉病一例

目的报道1例因多变根毛霉引起的面部感染。方法经真菌镜检、培养和病理诊断为面部多变根毛霉病。结果患者5岁,因摔跤行鼻骨复位术后,面部出现红色丘疹,斑块,肉芽肿,2003年来我院诊断为面部毛霉病。2004年2月根据药敏试验选择酮康唑200 mg／d治疗2个月好转。因其他原因停止治疗,7个月后病情恶化,面部浸润性斑块,坏死,结黑色痂,脓性分泌物,上唇和上腭部分缺失,再次真菌镜检和培养鉴定为多变根毛霉。2004年12月给予两性霉素B治疗2个月,总剂量为50 mg／kg,明显好转,加用伊曲康唑 100 mg／d治疗。结论多变毛霉可引起皮肤组织浸润性感染,两性霉素B治疗有效。

Facial Mucormycosis due to Rhizomucor variabilis: A Case Report

A five-year-old girl was admitted to our institute for the skin lesions on the face for about 6 months. She was injured in May 2003, radiography and CT demonstrated fracture of her nasal bone, and reposition of the nasal bone was performed in a local hospital. The skin lesions began with reddish papules 20 days after the operation and slowly developed into plaques and granuloma. Direct microscopic examination, fungal culture and pathological findings confirmed the diagnosis of facial mucormycosis due to Rhizomucor variabilis. In vitro susceptibility test indicated the pathogen was sensitive to ketoconazole but insensitive to fluconazole, itra-conazole or terbinafine. Then ketoconazole was administrated systemically and topically. The treatment was effective but was stopped about 2 months later because of some reasons. Seven months after the stopping the lesions aggravated and she was admitted to our institute again at the end of 2004, the second fungal culture found the same pathogen and the susceptibility test showed ketoconazole could not inhibit the fungus any more. Then am-photericin B was administrated for about 2 months with a total dose of 50 mg/kg. At the end of the second treatment the lesions improved remarkably. Three consecutive fungal and pathologic examinations could not find any clue of the fungus. Then the girl was discharged with oral administration of itraconazole 100 mg per day as the maintenance dosage. The patient is in follow-up until now. Our results show amphotericin B is effective for the treatment of mucormycosis.