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首页> 外文期刊>Frontiers in Medicine >Case Report: Rhizopus arrhizus Rhino-Orbital-Cerebral Mycosis and Lethal Midline Granuloma: Another Fungal Etiological Agent
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Case Report: Rhizopus arrhizus Rhino-Orbital-Cerebral Mycosis and Lethal Midline Granuloma: Another Fungal Etiological Agent

机译：病例报告：Rhizopus Arrhizus rhino-orbital-脑肌霉菌和致死中线肉芽肿：另一种真菌病因

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Objective: Both rhino-orbital-cerebral mycosis and lethal midline granuloma (LMG) may result in midline destruction. LMG has now been generally considered as a natural killer/T cell lymphoma, nasal type (ENKTL-NT) with an association of EBV. Fungi have been detected from the diseased tissues now and then but are often considered as lymphoma-associated infections. We previously reported an ENKTL-NT case with Mucor irregularis , which played a causal role in the disease and was involved in the overexpression of Ki67 and CD56 in the mouse experiment. The present study describes a chronic Rhizopus arrhizus infection with immunological parameters that are closely similar to LMG. We aim to explore the relationship of another Mucorales fungus, R. arrhizus , and LMG in a patient and in mice. Methods: Case study and mouse infection modules were designed for our observation. A 35-year-old man with midline face ulcers which was clinically suspected as LMG was selected. Biopsy specimens were sent for lymphoma diagnosis and microbiological detection. The isolated fungus was tested in an ICR mouse model for mycological and histological analyses. Results: Five tissue samples yielded Rhizopus arrhizus . In the pathology, characteristic inflammation, necrosis, and granulation with thin-walled hyphae are observed. Immunohistochemistry showed NK/T cell infiltration (CD3+, CD8+, TIA1+, GZMB+, PRF+, individual CD56+) with hyperplasia (Ki67+) and angioinvasion. The patient recovered completely with amphotericin B. In the murine experiment, R. arrhizus caused angioinvasion with NK/T cell infiltration (CD3+, CD56+, TIA1+, GZMB +, PRF+) with proliferation (Ki67+) and was re-isolated from the infected host. Conclusions: We here describe a mid-face destruction patient, which was diagnosed by the top pathologists in China according to the current criteria of NK/T cell lymphoma, with a negative result for EBV and positive result for R. arrhizus . With a then developed mouse experiment, the R. arrhizus in the diseased lesions was responsible for the NK/T cell infiltration (CD3+, CD8+, CD56+, TIA1+, GZMB+, PRF+), proliferation (Ki67+), and angioinvasion, suggesting another fungal etiological agent for LMG, which could be eradicated with amphotericin B. Limitations: The sample size is not sufficient for statistical analysis. However, our findings are suggestive for the role fungus plays in LMG.
机译：目的：犀牛眶 - 脑肌菌和致死中线肉芽肿（LMG）可能导致中线破坏。 LMG现已被认为是具有EBV关联的天然杀伤/ T细胞淋巴瘤，鼻型（ENKTL-NT）。已经从患病组织中检测到真菌，然后往往被认为是淋巴瘤相关的感染。我们之前报道了粘膜不规则的ENKTL-NT病例，这在疾病中起着因果作用，并且参与了小鼠实验中KI67和CD56的过表达。本研究描述了一种慢性根瘤兽arrhizus感染，具有与LMG密切相关的免疫学参数。我们的目标是探讨另一种粘液真菌，R.Grhizus和LMG在患者和小鼠中的关系。方法：设计案例研究和小鼠感染模块用于我们的观察。选择了一名35岁的男子，中线面部溃疡被选中，临床疑似LMG。将活检标本置于淋巴瘤诊断和微生物检测。在ICR小鼠模型中测试了分离的真菌，用于Mycological和组织学分析。结果：五种组织样品产生Rhizopus Arrhizus。在病理学中，观察到具有薄壁菌丝的特征性炎症，坏死和粒状。免疫组织化学显示NK / T细胞浸润（CD3 +，CD8 +，TIA1 +，GZMB +，PRF +，单个CD56 +，单个CD56 +），具有增生（Ki67 +）和血管素。患者用两性霉素B恢复。在鼠实验中，R. Arrhizus导致NK / T细胞浸润（CD3 +，CD56 +，Tia1 +，GZMB +，PRF +，GZMB +，PRF +）的血管诱导（Ki67 +），并从受感染的宿主重新分离。结论：我们在这里描述了一种中脸破坏患者，其根据NK / T细胞淋巴瘤的当前标准被中国的顶部病理学家诊断出来，eBV和R.RARHIZUS的阳性结果为阴性结果。随着患有鼠标实验，患病病变中的R.Rarhizus负责NK / T细胞浸润（CD3 +，CD8 +，CD56 +，TIA1 +，GZMB +，PRF +），增殖（KI67 +）和血管素，表明另一种真菌病因用于LMG的剂，其可以用两性霉素B消除。限制：样品大小不足以进行统计分析。然而，我们的研究结果对LMG中的角色戏剧呈现。

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