慢性鼻腦型白黴菌症－病例報告

鼻腦型白黴菌症在臨床上大多以亞急性或猛爆性的型式來表現，且幾乎都見於糖尿病或免疫不全的病人。相對地，慢性鼻腦型白黴菌症卻十分罕見。本院於1997年曾診治1名68歲男性病患，主訴持續左側眼睛後疼痛3個月並發生眼外肌麻痺及視力模糊，經電腦曾攝影檢查懷疑是鼻竇炎所致因而會診本科。病人接受內視鏡手術，將發炎軟組織及息肉切除，並將眼框內側紙狀板部分切除。手術過程中未發現明顯黴菌球或黴菌結石。術後病理報告為白黴菌症。於是立即接受amphotericin B 的治療。本例病人在累積劑量到1.49g即出現嚴重腎毒性，再進一步鼻竇內視鏡及電腦斷層檢查並無明顯病灶下，即予停藥觀察。追蹤至今一年半，並無復發跡象。(中耳醫誌 2000: 35:263-266)

關鍵字

Amphoyericin B ；慢性白黴菌症；鼻腦型

並列摘要

Chronic rhinocerebral mucormycosis (CRM), as distinct from the acute fulminating form , is extrely unusual. With chronic infection, the disease course is indolent and slowly progressive, often occurring over weeks to months, We present a 68-year-old man who had laft retrobulbar pain and ophthalmopegia. Computed tomographic scanning demonstrated opacification of the laft sphenoid, and ethmoid sinuses, with a soft tissue density extending into the laft orbital apex. The patient underwent endoscepic sinus surgeruy. The pathological diagnosis was mucormycosis, The patient’s ophthalmople-gia resolved completely pver the next several weeks with amphotericin B therapy. The patient was free of active disease 18 months later. A diagnosis of chronic rhinocerebral mucormycosis should be considered if an immunocompromised patient has exhibited obscure headache and ophthalmologic findings over a number of weeks, The optimal treat-ment of CRM often invowes conservative surgical debridement combined with ampho-tericin B therapy.

並列關鍵字

Amphotericin B ； chronic mucormycosis ； rhinocerebral

國際替代計量

慢性鼻腦型白黴菌症－病例報告

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