鼻眼窩腦白黴菌病－病例報告

本文報告一例糖尿病合併肝硬化患者，罹患鼻眼窩腦白黴菌的病例（rhino-orbital-cerebral mucormycosis），主要表現為間歇性之發燒、白血球增多、急鼻竇炎、及右眼眼窩蜂窩組織炎，因此接受鼻竇內視鏡手術（endoscopic sinus surgery），清除鼻竇內壞死組織，病理切片可見分支且無分隔之菌絲，黴菌培養為R hizopus，並開始注射amphotericin B，但病人仍出現右眼眼瞼下垂、眼球運動障礙、凸眼、眼壓增高之眼窩尖症候群（orbital apex syndrome），及視網膜中央動脈阻塞。最後因疑似海線靜脈竇栓塞（cavernous sinus thrombosis）併大腦梗塞死亡。

關鍵字

眼窩；白黴菌病；鼻竇內視鏡手術

並列摘要

We describe a case of rhino-orbital-cerebral mucormycosis in a female, 40-year-old patient with preexising diabetes mellitus and liver cirrhosis. Initially, intermittent fever, leukocytosis, acute paranasal sinusitis, and right orbital cellultis were noted. Functional endoscopic sinus surgery was performed to remove necrotic tissue. Branching, nonseptate hyphae were seen on pathological examination. Fungus culture revealed rhizopus. Intravenous amphotericin B (90 mg/day) was given for treatment of mucormycosis. Three days later, orbital apex syndrome, central retinal artery occlusion, and ischemic optic neuropathy of the right eye appeared with the symptoms of sudden blindness, blepharoptosis, proptosis, and limitation of eye movement. The patient died of suspected cavernous sinus thrombosis and cerebral infarct next day.

並列關鍵字

orbit ； mucormycosis ； endoscopic sinus surgery

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鼻眼窩腦白黴菌病－病例報告

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