侵犯鼻腔眼窩的白黴菌病：一名糖尿病病例報告

Rhino-orbital Mucormycosis in a Diabetic Patient: A Case Report

白黴菌病(Mucormycosis)為臨床上罕見的黴菌感染，以侵犯糖尿病和血液病等免疫不全的病人為主。不受控制的免疫不全病症皆易使患者在鼻腔、眼窩及顱內等部位感染到危及生命的白黴菌病。我們報告一位糖尿病控制不佳的45歲男性，出現了兩周的左鼻部疼痛，頭痛及發燒等病史。鼻咽切片顯示為黴菌感染。用liposomal amphotericin B治療兩周後臨床症狀改善即出院，在門診接受積極血糖控制治療且未接受抗黴菌的降壓治療。3個月後HbA1c降到5.9%，且患者的白黴菌病也未曾再復發。通常白黴菌病都須經由反覆的手術清創來完成治療，但也可以如同本個案一般，簡單地或選擇性地通過藥物給予和控制潛在的免疫不全條件來進行治療成效，病人也有良好的預後。本案例為臨床高度警覺、及時診斷與替代治療策略選擇提供了重要的參考價值。

Mucormycosis is a rare opportunistic fungal infection that occurs mainly in immunocompromised patients such as those with diabetes and blood diseases. Uncontrolled underlying immunocompromising conditions predispose patients to rhino-orbital-cerebral mucormycosis, which is life-threatening. We report a 45-year-old man with uncontrolled type 2 diabetes mellitus presenting with a two-week history of left nasal pain, headache, and fever. The biopsy of nasopharynx revealed fungal infection. After a two-week treatment with liposomal amphotericin B, his clinical condition improved. He was discharged and followed-up at our clinic for diabetes treatment without antifungal step-down therapy. At the 3-month follow-up, his HbA1c level had decreased to 5.9% without mucormycosis recurrence. Conventionally, mucormycosis is treated by surgical debridement, but it can also be simply and alternatively treated via medical therapy and the control of underlying immunocompromising conditions, as we have in this case. This case provides the important reference values for clinical alertness, prompt diagnosis, and alternative treatment strategy.