以双侧颅神经麻痹为临床表现的鼻眶脑毛霉菌病的临床特点(附1例报告)OACSTPCD
Clinical features of rhino-orbital-cerebral mucormycosis with bilateral cranial nerves paralyze as the clinical manifestation(report of one case)
目的 探讨以双侧颅神经麻痹为临床表现的鼻眶脑毛霉菌病(ROCM)的临床特点.方法 回顾性分析1 例以双侧颅神经麻痹为临床表现的ROCM患者的临床资料,并结合相关文献进行分析讨论.结果 本例患者青年男性,既往体健,有新发糖尿病及糖尿病酮症酸中毒.该患者急性起病,进展迅速,出现双眼失明、双上眼睑下垂和眼外肌麻痹,CSF二代测序、真菌荧光染色涂片和培养均证实存在毛霉菌.虽然早期积极给予有效抗真菌治疗,但是患者迅速出现脑出血及脑疝,最终自动出院后死亡.结论 ROCM是罕见的高死亡率感染性疾病.对于糖尿病/糖尿病酮症酸中毒患者,当双侧颅神经麻痹作为临床症状且不能用其他病变解释时,建议考虑是否存在ROCM.CSF二代测序有助于快速诊断.
Objective To investigate the clinical features of rhino-orbital-cerebral mucormycosis(ROCM)with bilateral cranial nerve palsies as the clinical manifestation.Methods The related clinical data about ROCM with bilateral cranial nerve palsy as a clinical manifestation was collected,analyzed as well as discussed in the manuscript.And the relevant literatures were reviewed.Results This patient was a healthy young man with new-onset diabetes and diabetic ketoacidosis.The patient developed rapidly with acute onset,bilateral blindness,blepharoptosis and extraocular muscle paralysis.The presence of mucormycosis was confirmed by CSF second-generation sequencing,fungal fluorescent staining and culture.Although effective antifungal therapy was performed early,but the patient quickly presented with cerebral hemorrhage and herniation.Eventually,the patient died after discharge.Conclusions ROCM is a rare and high-mortality infectious disease.This case indicated that the clinicians should consider the presence of ROCM in patients with diabetes/diabetic ketoacidosis when the bilateral cranial nerves paralysis are the clinical symptom,whicn can not be explained by other lesions.CSF next-generation sequencing is helpful for rapid diagnosis.
郑晓彧;杨洪娜;方巍
250000 济南,山东大学山东省立医院重症医学科山东第一医科大学附属省立医院重症医学科
临床医学
鼻眶脑毛霉菌病双侧颅神经麻痹脑出血二代测序糖尿病酮症酸中毒
rhino-orbito-cerebral mucormycosisbilateral cranial nerves paralysisbrain herniationnext-generation sequencingdiabetic ketoacidosis
《临床神经病学杂志》 2024 (002)
109-112 / 4
国家自然科学基金(81701057)
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