切换至 "中华医学电子期刊资源库"

中华移植杂志(电子版) ›› 2026, Vol. 20 ›› Issue (02) : 118 -122. doi: 10.3877/cma.j.issn.1674-3903.2026.02.008

经验交流

肾移植术后非供者来源结肠毛霉菌病一例并文献复习
郑慧1, 刘杨艳1, 骆静1, 张莉2, 赵庆洪3, 戴春笋1, 顾民4, 曹红娣1,()   
  1. 12100003 南京,南京医科大学第二附属医院肾脏病中心
    22100003 南京,南京医科大学第二附属医院药学部
    32100003 南京,南京医科大学第二附属医院普外科
    42100003 南京,南京医科大学第二附属医院泌尿外科
  • 收稿日期:2025-11-21 出版日期:2026-04-25
  • 通信作者: 曹红娣
  • 基金资助:
    南京医科大学第二附属医院-滨海县人民医院联合科技提升项目(EFYBH03B,EFYBH09A); 南京市卫生健康委员会一般性课题(YKK23291)

Non-donor-derived colonic mucormycosis after kidney transplantation: a case report and literature review

Hui Zheng1, Yangyan Liu1, Jing Luo1, Li Zhang2, Qinghong Zhao3, Chunsun Dai1, Min Gu4, Hongdi Cao1,()   

  1. 1Department of Nephrology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
    2Department of Pharmacy, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
    3Department of General Surgery, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
    4Department of Urology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
  • Received:2025-11-21 Published:2026-04-25
  • Corresponding author: Hongdi Cao
引用本文:

郑慧, 刘杨艳, 骆静, 张莉, 赵庆洪, 戴春笋, 顾民, 曹红娣. 肾移植术后非供者来源结肠毛霉菌病一例并文献复习[J/OL]. 中华移植杂志(电子版), 2026, 20(02): 118-122.

Hui Zheng, Yangyan Liu, Jing Luo, Li Zhang, Qinghong Zhao, Chunsun Dai, Min Gu, Hongdi Cao. Non-donor-derived colonic mucormycosis after kidney transplantation: a case report and literature review[J/OL]. Chinese Journal of Transplantation(Electronic Edition), 2026, 20(02): 118-122.

图1 肾移植术后结肠毛霉菌感染受者移植后第20天肠镜表现及肠黏膜组织病理结果(HE ×100)注:a~c.结肠多发性溃疡,溃疡周围黏膜水肿发红,溃疡面覆丝状白苔;d.肠黏膜组织病理染色示中度慢性炎症,局灶变性坏死组织内见少量红染无定形组织
图2 肾移植术后结肠毛霉菌感染受者移植后第28天肠镜表现及切除结肠组织病理结果(HE ×100)注:a~b.结肠多发溃疡,与肾移植术后第22天对比,溃疡周围水肿减轻,边界清晰;c.回盲部溃疡面覆大量黄绿色丝状苔;d.切除结肠组织病理染色示结肠肠壁全层急慢性炎细胞浸润伴多灶性溃疡形成及局灶穿孔,坏死组织内见大量菌丛伴组织细胞、多核巨细胞反应
表1 肾移植受者结肠毛霉菌病病例的临床特征、治疗及结局
作者 发表年份 年龄(岁) 性别 供肾类型 危险因素 发病时间 临床表现 治疗措施 移植肾切除 结局
Tinmouth等[6] 2001 57 遗体器官捐献 皮质类固醇、大剂量糖皮质激素冲击治疗、环孢素、霉酚酸、他克莫司 术后2个月 腹痛、便秘 停用霉酚酸、降低他克莫司血药浓度,予两性霉素B,行脾脏+胃底+隔膜+脾屈曲+降结肠切除术 死亡
Ju等[7] 2001 33 活体 皮质类固醇、环孢素、OKT3 术后23 d 便血 停用除类固醇以外的所有免疫抑制剂,予两性霉素B +人免疫球蛋白,行移植肾切除术 存活
Sehgal等[8] 2004 57 活体 霉酚酸酯、环孢素、甲泼尼龙、硫唑嘌呤 术后6个月 腹膜炎症状 停用所有免疫抑制剂,予两性霉素B,行开腹手术将横结肠穿孔外置作为造口 死亡
Echo等[9] 2005 43 未说明 兔抗人胸腺细胞免疫球蛋白诱导、霉酚酸酯、泼尼松、西罗莫司 术后91 d 鲜血便 停用所有免疫抑制剂,予脂质体两性霉素B,行右半结肠切除术+末端回肠造口术+移植肾切除术 存活
Prasad等[10] 2006 42 活体 因急性排斥反应予静脉甲泼尼龙、环孢素、硫唑嘌呤 术后22 d 上腹痛、咯血、鲜血便 予两性霉素B,行远端胃楔形切除和胃造口术 存活
Lalwani等[11] 2012 35 活体 泼尼松龙、霉酚酸酯、他克莫司、术后早期抗胸腺细胞免疫球蛋白 术后45 d 不明原因贫血 结肠镜肾上腺素注射失败,行右半结肠切除术+回肠横断侧侧吻合术 存活
Johnson等[12] 2013 43 遗体器官捐献 泼尼松、霉酚酸、他克莫司 术后23 d 便血 予两性霉素B,行结肠次全切除术+暂时回肠造口术 存活
Barnajian等[13] 2014 66 遗体器官捐献 他克莫司、霉酚酸酯、近期中性粒细胞减少 不详 疲劳、发热、呼吸急促、腹痛 予禁食/肠外营养、哌拉西林-他唑巴坦、甲硝唑、阿奇霉素、氟康唑均失败,行右半结肠切除术+末端回肠造口术 死亡
Nandwani等[14] 2015 45 活体 利妥昔单抗、霉酚酸酯、他克莫司 术后4周 腹痛、呕吐 予两性霉素B,行远端胃切除术以及清创和空肠造口术 死亡
Busbait等[15] 2020 64 未说明 霉酚酸、他克莫司、反复中性粒细胞减低 术后10年 腹痛、呕吐 予两性霉素B脂质体,行右半结肠切除术伴回肠末端造口术 死亡
1
Gandhi BV, Bahadur MM, Dodeja H, et al. Systemic fungal infections in renal diseases[J]. J Postgrad Med, 2005, 51(Suppl 1):S30-S36.
2
Kontoyiannis DP, Marr KA, Park BJ,et al. Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001-2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database[J]. Clin Infect Dis, 2010, 50(8):1091-1100.
3
Uppuluri P, Alqarihi A, Ibrahim AS. Mucormycoses[M]//Encyclopedia of Mycology. Amsterdam: Elsevier, 2021:600-612.
4
Alqarihi A, Kontoyiannis DP, Ibrahim AS. Mucormycosis in 2023: an update on pathogenesis and management[J]. Front Cell Infect Microbiol, 2023, 13:1254919.
5
Palomba E, Colaneri M, Azzarà C, et al. Epidemiology, clinical manifestations, and outcome of mucormycosis in solid organ transplant recipients: a systematic review of reported cases[J]. Open Forum Infect Dis, 2024, 11(6):ofae043.
6
Tinmouth J, Baker J, Gardiner G. Gastrointestinal mucormycosis in a renal transplant patient[J]. Can J Gastroenterol, 2001, 15(4):269-271.
7
Ju JH, Park HS, Shin MJ, et al. Successful treatment of massive lower gastrointestinal bleeding caused by mixed infection of cytomegalovirus and mucormycosis in a renal transplant recipient[J]. Am J Nephrol, 2001, 21(3):232-236.
8
Sehgal A, Raghavendran M, Kumar D, et al. Rhinocerebral mucormycosis causing basilar artery aneurysm with concomitant fungal colonic perforation in renal allograft recipient: a case report[J]. Transplantation, 2004, 78(6):949-950.
9
Echo A, Hovsepian RV, Shen GK. Localized cecal zygomycosis following renal transplantation[J]. Transpl Infect Dis, 2005, 7(2):68-70.
10
Prasad N, Ram R, Satti Reddy V, et al. Non-fatal gastric mucormycosis in a renal transplant patient and review of the literature[J]. Transpl Infect Dis, 2006, 8(4):237-241.
11
Lalwani S, Govindasamy M, Gupta M, et al. Gastrointestinal mucormycosis-four cases with different risk factors, involving different anatomical sites[J]. Indian J Gastroenterol, 2012, 31(3):139-143.
12
Johnson JB, Affolter KE, Samadder NJ. A rare cause of hematochezia: colon mucormycosis[J]. Clin Gastroenterol Hepatol, 2013, 11(8):A22.
13
Barnajian M, Gioia W, Iordache F, et al. Mucormycosis-induced colon perforation after renal transplantation[J]. Surg Infect (Larchmt), 2014, 15(5):665-666.
14
Nandwani A, Jha PK, Duggal R, et al. Invasive gastric mucormycosis and cytomegalovirus infection in an ABO incompatible renal transplant recipient[J]. Indian J Nephrol, 2015, 25(6):373-376.
15
Busbait S, AlMusa Z, Al Duhileb M, et al. A cecal mucormycosis mass mimicking colon cancer in a patient with renal transplant: a case report and literature review[J]. Am J Case Rep, 2020, 21:e926325.
16
Chamilos G, Lewis RE, Kontoyiannis DP. Delaying amphotericin B-based frontline therapy significantly increases mortality among patients with hematologic malignancy who have zygomycosis[J]. Clin Infect Dis, 2008, 47(4):503-509.
17
Sharma A, Alam MA, Dhoundiyal S, et al. Review on mucormycosis: pathogenesis, epidemiology, microbiology and diagnosis[J]. Infect Disord Drug Targets, 2024, 24(1):e220823220209.
18
Lanternier F, Sun HY, Ribaud P, et al. Mucormycosis in organ and stem cell transplant recipients[J]. Clin Infect Dis, 2012, 54(11):1629-1636.
19
Cornely OA, Alastruey-Izquierdo A, Arenz D, et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium[J]. Lancet Infect Dis, 2019, 19(12):e405-e421.
20
Gebremariam T, Gu Y, Singh S, et al. Combination treatment of liposomal amphotericin B and isavuconazole is synergistic in treating experimental mucormycosis[J]. J Antimicrob Chemother, 2021, 76(10):2636-2639.
21
Vironneau P, Kania R, Morizot G, et al. Local control of rhino-orbito-cerebral mucormycosis dramatically impacts survival[J]. Clin Microbiol Infect, 2014, 20(5):O336-O339.
22
Gebremariam T, Liu M, Luo G, et al. CotH3 mediates fungal invasion of host cells during mucormycosis[J]. J Clin Invest, 2014, 124(1):237-250.
23
Warkentien TE, Shaikh F, Weintrob AC, et al. Impact of mucorales and other invasive molds on clinical outcomes of polymicrobial traumatic wound infections[J]. J Clin Microbiol, 2015, 53(7):2262-2270.
24
Gebremariam T, Alkhazraji S, Soliman SSM, et al. Anti-CotH3 antibodies protect mice from mucormycosis by prevention of invasion and augmenting opsonophagocytosis[J]. Sci Adv, 2019, 5(6):eaaw1327.
25
Gu Y, Singh S, Alqarihi A, et al. A humanized antibody against mucormycosis targets angioinvasion and augments the host immune response[J]. Sci Transl Med, 2025, 17(789):eads7369.
26
Moreno A, Mah J, Budvytiene I, et al. Dynamics and prognostic value of plasma cell-free DNA PCR in patients with invasive aspergillosis and mucormycosis[J]. J Clin Microbiol, 2024, 62(5):e0039424.
27
Kavaliauskas P, Gu Y, Hasin N, et al. Multiple roles for hypoxia inducible factor 1-alpha in airway epithelial cells during mucormycosis[J]. Nat Commun, 2024, 15(1):5282.
28
Andrianaki AM, Kyrmizi I, Thanopoulou K, et al. Iron restriction inside macrophages regulates pulmonary host defense against Rhizopus species[J]. Nat Commun, 2018, 9(1):3333.
29
Ibrahim AS, Voelz K. The mucormycete-host interface[J]. Curr Opin Microbiol, 2017, 40:40-45.
[1] 李萌, 张炳垚, 张倩, 朱冰洁, 张溪. 肾移植术后合并高血压致药物性牙龈肥大诊疗与4年观察随访1例[J/OL]. 中华口腔医学研究杂志(电子版), 2026, 20(03): 230-237.
[2] 杨波, 温爱萍, 马葵芬, 刘相端, 杨辉, 钱卿, 陈攀, 曾芳, 王融溶, 王广钊, 侯文婧. 中国23家肾移植中心抗菌药物管理现状调查[J/OL]. 中华移植杂志(电子版), 2026, 20(02): 91-95.
[3] 王琦, 慕晗梦, 马艳春, 王钢, 李红芹. 双重血浆置换和血浆置换对ABO血型不相容亲属活体肾移植受者术前血型抗体的清除效率及远期疗效比较[J/OL]. 中华移植杂志(电子版), 2026, 20(02): 96-103.
[4] 刘越, 贾婷婷, 黄良飞, 乔鹏飞, 刘飞, 侯善升, 王洪良. 肾移植术后惠普尔养障体肺部感染四例并文献复习[J/OL]. 中华移植杂志(电子版), 2026, 20(01): 65-70.
[5] 吴建永. 复杂肾移植相关手术技巧探索[J/OL]. 中华移植杂志(电子版), 2025, 19(06): 0-.
[6] 王博, 丁润民, 郑明, 倪斌, 王子杰, 顾民, 桂泽平. 新型慢性同种异体肾移植排斥反应小鼠模型的建立及单细胞深层表型分析[J/OL]. 中华移植杂志(电子版), 2025, 19(06): 398-407.
[7] 张小燕, 杜雨轩, 韩士超, 王国辉, 戚若晨, 徐桐, 刘克普, 吴东娟, 杨晓剑, 马帅军, 秦卫军. 中国西北地区肾移植术后腹泻临床诊治及危险因素分析[J/OL]. 中华移植杂志(电子版), 2025, 19(06): 431-436.
[8] 李伯钦, 朱一辰, 田野, 赵美姗. 人工智能在肾移植领域的应用进展[J/OL]. 中华移植杂志(电子版), 2025, 19(06): 482-485.
[9] 《肾脏常温机械灌注操作规范》编审组. 肾脏常温机械灌注操作规范[J/OL]. 中华移植杂志(电子版), 2025, 19(05): 308-313.
[10] 中国遗体捐献供肾质量评估专家共识编审组. 中国遗体捐献供肾质量评估专家共识[J/OL]. 中华移植杂志(电子版), 2025, 19(04): 205-217.
[11] 郑明, 房子凯, 杨铖铖, 刘康煜, 刘继先, 曹红娣, 骆静, 薛珺, 胡海斌, 朱清毅, 顾民, 沈百欣. 膀胱硬镜联合输尿管软镜治疗肾移植术后输尿管相关并发症17例诊疗经验[J/OL]. 中华移植杂志(电子版), 2025, 19(04): 259-263.
[12] 那淑芳, 李玲, 罗明, 叶啟发. Castleman病相关肾衰竭与肾移植预后[J/OL]. 中华移植杂志(电子版), 2025, 19(04): 274-279.
[13] 刘金泉, 王淑贤, 冯帅, 纪建磊, 许传屾. 供肾穿刺活检对体外膜肺氧合支持下循环衰竭合并急性肾损伤供者的临床评估价值[J/OL]. 中华移植杂志(电子版), 2025, 19(03): 181-184.
[14] 徐菁, 贺田, 沈晓佳, 汪淑敏, 吴林燕, 沈鸣雁, 寿张飞. 肾移植受者免疫抑制剂服药依从性与衰弱和电子健康素养的相关性研究[J/OL]. 中华移植杂志(电子版), 2025, 19(03): 170-174.
[15] 王嘉民, 刘平. 广东省医学会泌尿外科疑难病例多学科会诊(第27期)——肾移植术后原发膀胱癌[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(06): 809-814.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?