重症COVID-19感染伴白血病反应和毛霉菌病1例

Rand Sayed Issa, Gohar Mushtaq, A. Unnisa, A. Mahli
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摘要

目的白血病样反应(Leukemoid Reaction, LR)是指以成熟中性粒细胞为特征的白细胞增生。住院患者中LR的发生率约为1 %。毛霉病是一种罕见的,侵袭性的,致命的真菌感染,折磨免疫功能低下的患者。本研究讨论了一例重症COVID-19感染患者合并白血病反应和毛霉菌病的病例。一名确诊为SARS-CoV-2的45岁女性患者被送往医院,给予补充氧气并给予机械通气。她的皮肤活检显示无分隔菌丝和广角分支。她的血液检查也显示了LR的存在。结论重症COVID-19感染可引起新发高血糖,导致代谢性酸中毒,肾功能衰竭导致体内有毒代谢物积累,应激激素和炎症细胞因子释放,继发细菌和机会真菌感染。研究表明,严重COVID-19中的LR可能与严重感染(细菌或真菌)和体内其他病理生理变化有关。
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A case of concomitant leukemoid reaction and mucormycosis in a patient with severe COVID-19 infection
Abstract Objectives Leukemoid Reaction (LR) signifies leukocytosis characterized by mature neutrophils. The incidence of LR is about 1 % among hospitalized patients. Mucormycosis is a rare, aggressive, fatal fungal infection that afflicts immune-compromised patients. This study discusses the case of concomitant leukemoid reaction and mucormycosis in a patient with severe COVID-19 infection. Case presentation A 45-year-old female patient was presented to the hospital with confirmed SARS-CoV-2 and was given supplemental oxygen and placed on mechanical ventilation. Her skin biopsy revealed non-septate hyphae with wide-angle branching. Her blood tests also revealed the presence of LR. Conclusions Severe COVID-19 infection causes new-onset hyperglycemia, which can lead to metabolic acidosis, toxic metabolite accumulation in the body due to renal failure, the release of stress hormones and inflammatory cytokines, and the occurrence of secondary bacterial and opportunistic fungal infections. The study has shown that LR in severe COVID-19 may be associated with severe infections (bacterial or fungal) and other pathophysiological changes in the body.
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