由海豹链球菌所致过敏性真菌性鼻窦炎并发眶脓肿：一例罕见的动物源性鼻窦感染

文献信息

中文摘要

背景： 过敏性真菌性鼻窦炎（AFRS）继发细菌感染并不常见，但鉴于该疾病的膨胀性本质可导致分隔鼻窦与脑和眼眶的骨质变薄和侵蚀，因此可能很严重。动物源性病原体作为致病菌很少被涉及。
病例报告： 一名21岁非洲裔美国男性，有数年的进行性鼻塞、面部压迫感和嗅觉减退，因急性左眼疼痛和肿胀、复视、传入性瞳孔缺陷和下视野缺损急诊就诊。计算机断层扫描和磁共振成像显示急性加重性慢性鼻窦炎伴左侧眶脓肿。患者接受了急诊内镜鼻窦手术，并进行了左眶切开术和眶脓肿引流。术中所见、病理学、培养和过敏测试的回顾显示AFRS和一种新型动物源性细菌——海豹链球菌。
结论： 本病例代表了首例耳鼻喉科的海豹链球菌感染病例，一种严重且复杂的鼻窦和眶部感染。目前尚不清楚该感染的严重程度是这种不寻常病原体的结果，还是眼眶周围骨质长期变薄的结果，或两者兼有。尽管AFRS不被视为感染，但可能发生继发性细菌感染并导致严重并发症。早期手术干预和根据培养结果指导的治疗对于管理复杂的鼻窦疾病至关重要。

英文摘要

BACKGROUND: Secondary bacterial infections complicating allergic fungal rhinosinusitis (AFRS) are uncommon but can be serious given the expansile nature of the disease which can thin and erode the bone separating the sinuses from the brain and orbits. Zoonotic pathogens are rarely implicated as pathogens.
CASE REPORT: A 21-year-old African American male with several years of progressive nasal obstruction, facial pressure, and hyposmia, presented emergently with acute left eye pain and swelling, diplopia, afferent pupillary defect and inferior visual field deficit. Computed tomography and magnetic resonance imaging demonstrated acute on chronic sinusitis with a left orbital abscess. The patient underwent emergent endoscopic sinus surgery with left orbitotomy and drainage of the orbital abscess. Intraoperative findings, pathology, cultures, and allergy testing were reviewed demonstrating AFRS and a novel zoonotic bacterium, Streptococcus halichoeri.
CONCLUSIONS: This case represents the first otolaryngologic case of S. halichoeri infection, a severe and complicated sinus and orbital infection. It is unclear if the severity of this infection was a consequence of the unusual pathogen, of the long-term thinning of the bone around the orbit, or both. Although AFRS is not considered an infection, secondary bacterial infection may occur and cause severe complications. Early surgical intervention and culture-directed therapy are essential in managing complicated sinonasal diseases.