上顎白黴菌病骨髓炎－病例報告

白黴菌病是指由毛黴目下的病原菌所引起的一種伺機性且猛爆性黴菌感染，發病迅速且死亡率高，容易感染免疫功能不全和控制不佳的糖尿病患者。常見的傳染途徑是經宿主鼻腔吸入孢子造成吸呼道周圍組織感染，因此鼻眼腦型為臨床上最常遇到的類型。本病例是一位有肺結核和第二型糖尿病等潛在疾病的71歲男性，至本院就醫時，口腔瀰漫惡臭，有上顎骨暴露性壞死、鼻塞、左邊頭痛、左臉腫脹等症狀，無神經學症狀。磁振造影和電腦斷層攝影顯示廣泛性上顎骨及顎骨壞死、上顎竇、篩竇、與蝶竇發炎。住院期間以抗黴菌藥物治療，並進行部分上顎骨與腭骨切除、感染與壞死組織清創手術。門診追蹤期間，因鼻腔口腔相通處有化膿性滲出物，再次進行清創手術，術後傷口恢復良好。第二次手術後三個月，安排病人於贗復牙科接受閉孔器治療，有效地解決發音和美觀問題。目前於本科持續追蹤，依照感染科醫師建議，持續口服Posaconazole。肝腎功能與血糖控制正常，無復發跡象。

關鍵字

上顎骨；白黴菌病；糖尿病；免疫功能不全

並列摘要

Mucormycosis is an opportunistic and acute infection caused by the fungus Mucorales. It progresses rapidly and has a high mortality rate. It easily infects immunocompromised and uncontrolled DM patient. A common pathway of infectious is a host inhaling spores through his nasal cavity, thereby causing airway infection. Rhino-orbital-cerebral mucormycosis is the most encountered form in the clinical setting. This case is a 71 years old male diagnosed with parasinal mucormycosis by the ENT department of a local community hospital in June 2012 and underlying disease included DM, hypertension, ischemic heart disease, lung TB, treated with medication. On May 31, 2012, the patient was sent to the emergency department of a local community hospital for coma and epistaxis. He was diagnosed with Type I DM and chronic sinusitis. After DM was under control, the biopsy over maxillary sinus was performed and the result was mucormycosis. Following intravenous Amphotericin B treatment, his symptom began to ease but after one month the infection spread to the oral cavity, resulting in necrotic and exposed maxilla. The patient's family transferred the patient to our hospital for surgical debridement. Based on the radiographic and histopathology report, the patient was diagnosed with mucormycotic ostoemyelitis of maxilla. On September 1, 2012, the patient underwent partial maxillary and palatal osteotomy and debridement under general anesthesia. He recovered well after whole procedure. During the follow-up period, he experienced suppurant form oral-nasal communication. As a result, on February 23, 2013, the patient underwent second debridement under general anesthesia. After the second operation, the mucormycosis was under control well. Three months later, the patient was treated with dental obturator at our dental prosthetical department.

並列關鍵字

Mucormycosis ； Maxilla ； Diabetes mellitus ； Immunocompromised

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上顎白黴菌病骨髓炎－病例報告

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