A Case with Multiple Fungal Coinfections in a Patient who Presented with Pancoast Syndrome = A Case with Multiple Fungal Coinfections in a Patient who Presented with Pancoast Syndrome

국문 초록 (Abstract)

소아암 환자에서 발생하는 침습성 진균 감염은 사망과 후유증에 이르는 중대한 감염이다. 18세 남자 환자가 호중구감소 기간 동안 입원하여 치료받던 중 우측 견관절과 우측 팔에 감각이상과 신경쇠약을 호소하였고, 우측폐상엽의 폐렴이 진단되었다. 기관지의 조직학적 소견과 폐 수술검체에서 시행한 polymerase chain reaction (PCR)로 털곰팡이증을 확진하였으며, 흉수액의 PCR로 페니실리움 디쿰벤스 감염, 갈락토마난 항원법으로 아스페르길루스증을 추정하였다. 환자는 백혈병이 치료되지 못하고 Staphylococcus epidermidis 패혈증이 합병되어 사망하였다. 본 증례에서는 판코스트 증후군의 증상을 보인 환자에서 진단된 다발성 폐진균증을 보고 하는 바이다.

다국어 초록 (Multilingual Abstract)

Invasive fungal infection (IFI) is a serious threat to pediatric patients with cancer given high morbidity and mortality. We present an 18-year-old male with precursor T-cell lymphoblastic leukemia who developed Pancoast syndrome, presented with paresthesia and numbness in the right shoulder and arm during a neutropenic fever period. He was diagnosed with pneumonia in the right upper lung field. He was later found to have an invasive pulmonary fungal infection caused by multiple fungi species, including Rhizomucor, confirmed by histology and polymerase chain reaction (PCR) (proven infection), Penicillium decumbens diagnosed by PCR, and Aspergillus suspected from galactomannan assay (probable infection). Unfortunately, the patient's condition further worsened owing to the aggravation of leukemia, chemotherapy-induced neutropenia, and bacterial coinfection, leading to multiorgan failure and death. Here, we report a case of IFI caused by multiple fungal species that presented as Pancoast syndrome.