急性白血病の経過中に発症し肺塞栓症を呈した播種性ムーコル症の1例

A Case Report of Pulmonary Embolism Occurring in Disseminated Mucormycosis during the Course of Acute Leukemia

要旨　患者は78歳，女性．2001年12月に急性骨髄性白血病(AML：FAB分類M0)と診断された．すでに難治性歯周炎などの感染症を併発しており，化学療法は施行せず経過観察していた．2003年2月10日より発熱，右胸部痛が出現し，13日に前医受診．右上肺野に肺炎を認め，入院したが改善せず，22日に当院へ転院となった．白血病に合併した重症肺炎と診断し，入院時より抗生剤に加え，アスペルギルス症の可能性も考慮しmicafunginの投与を開始した．2月24日からはDICが疑われたため，danaparoidの投与を開始した．マイコプラズマ抗体価が上昇しており，26日よりPZFX(1,000mg/day)の投与を開始したが状態改善せず28日死亡した．剖検では右肺上幹動脈の血栓内にムーコルの菌塊を認め，その他，多臓器にムーコルの菌糸を認めた．本症例は，剖検にて播種性ムーコル症による肺血栓塞栓症と診断しえた貴重な症例と考え，報告する．

Summary

　A 78-year-old woman was admitted to our hospital on February 22, 2003, because of severe pneumonia during the course of acute leukemia. Antibiotics and antifungal agents were administered. Danaparoid was added on February 24 and PZFX(1,000mg/day) was combined with it because of the high titer of anti-mycoplasma pneumoniae antibody, but the patient didn’t improve and died on February 28. Autopsy findings revealed thrombi containing a lot of mucor hyphae in the right truncus superior artery. Mucor hyphae invading blood vessels and microemboli were revealed in multiple organs. Although disseminated mucormycosis in immunocompromised hosts is not rare, it was reported here to improve our understanding of pulmonary embolism occurring in disseminated mucormycosis.