Amphotericin B와 Fluconazole 병합요법으로 회복된 Trichosporon beigelii에 의한 파종성 감염증 1예
A Case of Disseminated Trichosporon beigelii Infection Treated with the Combination of Amphotericin B and Fluconazole
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Trichosporon beigelii에 의한 파종성 감염은 백혈구 감소증이 있는 면역약화 환자에서 드물게 발생하는데, amphotericin B 치료에 잘 반응하지 않아서 치명적인 결과를 보이는 경우가 많다. 저자들은 급성골수구성백혈병으로 진단받고 항암화학요법을 시행한 27세의 남자에서 T. beigelii 파종성 감염증 1예를 경험하였다. 환자는 범혈구 감소증 상태에서 발열이 발생하고 점차 전신에 다발성 피부 발진이 발생하였다. 연속적으로 4일간 시행된 혈액배양에서 T. beigelii가 동정되었으며, 복부 피부병변 생검, 객담 및 대변 배양에서도 모두 동일한 T. beigelii가 다수 분리되어 파종성 감염을 진단할 수 있었다. 생체외 항진균제 감수성 검사결과 분리된 균주의 amphotericin B MIC는 2 μg/mL, fluconazole 및 itraconazole MIC는 각각 4 μg/mL 및 1 μg/mL이었다. 환자는 비교적 초기에 amphotericin B와 fluconazole과의 병합요법 치료를 받았고, 동시에 G-CSF 및 성분채집백혈구 수혈을 실시한 결과, 호전되었다. 본 증례는 T. beigelii에 의한 파종성 감염을 조기에 진단하여 amphotericin B와 fluconazole의 병합요법과 백혈구 증가요법 등을 적극적으로 실시하면 파종성 감염증이 치료될 수 있음을 보여준다.
Abstract
Trichosporon beigelii is often resistant to the fungicidal effect of amphotericin B and can cause fatal disseminated infections in immunocompromised patients. We report a case of a disseminated T. beigelii infection with a favorable outcome in a patient with acute erythroleukemia and neutropenia. The patient presented a persistent fever, multiple erythematous skin lesions, and pulmonary infiltrates. T. beigelii was isolated from blood cultures in four days and also from cultures of abdominal skin lesion, sputum, and stool. The isolate was resistant to amphotericin B (MIC, 2 μg/mL), and the respective fluconazole and itraconazole MICs were 4 and 1 μg/mL. The patient was successfully treated with fluconazole plus amphotericin B in combination with granulocyte colony stimulating factor and leukocyte transfusion. This case shows the importance of early diagnosis and treatment with combination of amphotericin B and fluconazole as a prognostic factor of disseminated T. beigeliiinfections.
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