糖尿病酮症酸中毒继发播散型毛霉病1例 及文献回顾

Diabetic Ketoacidosis with Secondary Disseminated Mucormycosis: A Case Report and Literature Review

摘要: 目的：探讨播散型毛霉病的临床特征、诊断思路及治疗方案，以期提高临床医生对该病的早期识别与诊治能力。方法：回顾性分析1例由糖尿病酮症酸中毒(DKA)诱发的鼻–眶–脑及肺部播散型毛霉病患者的临床资料，并复习相关文献。结果：患者为38岁男性，因左侧颜面部肿胀入院。既往糖尿病史多年且血糖控制极差。入院后经鼻窦组织宏基因组二代测序(mNGS)检出德氏根霉。影像学示感染已累及鼻窦、眼眶、颅内(颞叶)及肺部。给予艾沙康唑抗真菌治疗联合外科手术清创，并严密控制血糖，患者病情改善，体温恢复正常。结论：播散型毛霉病起病急、进展快、致死率高。对于存在DKA等高危因素的患者，早期行组织学检查或mNGS对确诊至关重要。联合外科清创与新型三唑类药物(如艾沙康唑)是个性化治疗的关键。

Abstract: Objective: To explore the clinical characteristics, diagnostic approaches, and therapeutic strategies for disseminated mucormycosis, aiming to enhance clinicians’ capacity for early recognition, diagnosis, and treatment of this disease. Methods: The clinical data of a 38-year-old male patient with rhino-orbito-cerebral and pulmonary disseminated mucormycosis induced by diabetic ketoacidosis (DKA) were retrospectively analyzed, followed by a review of the relevant literature. Results: The patient presented with swelling of the left facial region. He had a long-standing history of diabetes with poorly controlled blood glucose levels. Following admission, Rhizopus delemar was detected in sinonasal tissue via metagenomic next-generation sequencing (mNGS). Imaging studies revealed that the infection had involved the paranasal sinuses, orbits, intracranial structures (temporal lobe), and lungs. Following treatment with isavuconazole antifungal therapy combined with surgical debridement and intensive glycemic control, the patient’s condition improved, and body temperature returned to normal. Conclusion: Disseminated mucormycosis is characterized by rapid onset, swift progression, and high mortality rates. For patients with high-risk factors such as DKA, early histological examination or mNGS is crucial for a definitive diagnosis. The combination of surgical debridement and novel triazoles (such as isavuconazole) is the key to personalized treatment.