급성 백혈병 환자에서 타장기 침범 없이 다발성 피부 병변으로 발현한 파종 아스페르길루스증 1예
A Case of Disseminated Aspergillosis Presenting Solely as Multiple Cutaneous Lesions in an Acute Leukemia Patient
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Invasive aspergillosis (IA) is a major cause of morbidity and mortality in patients with hematological malignancies. While the development of new effective antifungals and advancement of diagnostic techniques have lead to improved outcomes, relapse of IA in patients with subsequent immunosuppression is emerging as a major issue. The primary IA site is the most common relapse site, but disseminated infection from the lung to multiple organs, including the brain, thyroid, liver, spleen, kidney, bone,heart valve, and skin, can often occur in patients with severe immunosuppression. Furthermore, relapsing or disseminated IA have very poor outcomes. We report a case of disseminated IA presenting as multiple cutaneous lesions without involvement of any other organs in an acute leukemia patient. The patient had suffered from prior invasive pulmonary aspergillosis, which was treated successfully. The multiple skin lesions were fully resolved after antifungal therapy for 6 weeks.
Abstract
Invasive aspergillosis (IA) is a major cause of morbidity and mortality in patients with hematological malignancies. While the development of new effective antifungals and advancement of diagnostic techniques have lead to improved outcomes, relapse of IA in patients with subsequent immunosuppression is emerging as a major issue. The primary IA site is the most common relapse site, but disseminated infection from the lung to multiple organs, including the brain, thyroid, liver, spleen, kidney, bone,heart valve, and skin, can often occur in patients with severe immunosuppression. Furthermore, relapsing or disseminated IA have very poor outcomes. We report a case of disseminated IA presenting as multiple cutaneous lesions without involvement of any other organs in an acute leukemia patient. The patient had suffered from prior invasive pulmonary aspergillosis, which was treated successfully. The multiple skin lesions were fully resolved after antifungal therapy for 6 weeks.
참고문헌 (20)
- Mandell GL, "Principles and Practice of Infectious Diseases", pp.3495~ (2005), Elsevier Churchill Livingstone
- Maschmeyer G, "Invasive aspergillosis: epidemiology, diagnosis and management in immunocompromised patients", Drugs, 67, pp.1567~1601 (2007)
- Lass-Florl C, "The changing face of epidemiology of invasive fungal diseases in Europe", Mycoses, 52, pp.197~205 (2009)
- 유진홍, "혈액질환 환자에서 조혈모세포 이식과화학요법 후의 침습성 진균감염의 분석", Infection and Chemotherapy, 36(1), pp.40~45 (2004), 대한감염학회
- Lin SJ, "Aspergillosis case-fatality rate: systematic review of the literature", Clin Infect Dis, 32, pp.358~366 (2001)
- Sun Hee Park, "Current Trends of Infectious Complications following Hematopoietic Stem Cell Transplantation in a Single Center", Journal of Korean Medical Science, 21(2), pp.199~207 (2006), 대한의학회
- van Burik JA, "Cutaneous aspergillosis", J Clin Microbiol, 36, pp.3115~3121 (1998)
- 서종근, "신장이식 환자에서 발생한 피부 침범을 보인 침습성 아스페르길루스증 1예", 대한피부과학회지, 47(10), pp.1190~1192 (2009), 대한피부과학회
- Park JH, "Disseminated aspergillosis with cutaneous aspergillosis and aspergergillus thyroiditis in a renal allograft recipient", Korean J Med, 60, pp.85~91 (2001)
- Kim YS, "Clinical study on invasive aspergillosis", Korean J Med, 38, pp.526~538 (1990)
- D'Antonio D, "Cutaneous aspergillosis in patients with haematological malignancies", Eur J Clin Microbiol Infect Dis, 19, pp.362~365 (2000)
- Hope WW, "The invasive and saprophytic syndromes due to Aspergillus spp", Med Mycol, 43(Suppl 1), pp.207~238 (2005)
- De Pauw B, "European Organization for Research and Treatment of Cancer", Invasive Fungal Infections Cooperative Group; National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC, invasive fungal infections cooperative group and the national institute of allergy and infectious diseases mycoses study group (EORTC, pp.MSG) consensus group, Clin Infect Dis[DOI]
- Cornely OA, "Multinational Case Registry of the Infectious Diseases Working Party of the German Society for Hematology and Oncology. Risk factors for breakthrough invasive fungal infection during secondary prophylaxis", J Antimicrob Chemother, 61, pp.939~946 (2008)
- Sipsas NV, "Clinical issues regarding relapsing aspergillosis and the eff icacy of secondary antifungal prophylaxis in patients with hematological malignancies", Clin Infect Dis, 42, pp.1584~1591 (2006)
- Upton A, "Invasive aspergillosis following hematopoietic cell transplantation: outcomes and prognostic factors associated with mortality", Clin Infect Dis, 44, pp.531~540 (2007)
- Fukuda T, "Invasive aspergillosis before allogeneic hematopoietic stem cell transplantation: 10-year experience at a single transplant center", Biol Blood Marrow Transplant, 10, pp.494~503 (2004)
- Offner F, "Impact of previous aspergillosis on the outcome of bone marrow transplantation", Clin Infect Dis, 26, pp.1098~1103 (1998)
- 배기선, "침습성 아스페르길루스증으로 치료받았던 급성 백혈병 환자에서 조혈모세포이식 후 발생한 파급성 아스페르길루스증 1례", Infection and Chemotherapy, 35(4), pp.221~225 (2003), 대한감염학회
- Walsh TJ, "Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America", Clin Infect Dis, 46, pp.327~360 (2008)