Neobična manifestacija gastričnog tipa mukormikoze kod bolesnice sa reumatoidnim artritisom

  • Marija Milić Perović University Medical Center Zvezdara, Department of Pathology, Belgrade, Serbia
  • Nenad Šolajić University of Novi Sad, Faculty of Medicine, Department of Pathology, Novi Sad, Serbia
  • Lidija Vučković Hardi General Hospital Subotica, Department of Pathology, Subotica, Serbia
  • Tamara Knežević Ivanovski University Medical Center Zvezdara, Department of Gastroenterology, Belgrade, Serbia
  • Jovan Juloski University Medical Center Zvezdara, Surgery Clinic “Nikola Spasić”, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP200731020M
Ključne reči: artritis, reumatoidni, dijagnoza, dijagnoza, diferencijalna, digestivni sistem, histološke tehnike, mukormikoza

Sažetak


Uvod. Mukormikoza je oportunistička infekcija koja ugrožava život, čija je incidenca u značajnom porastu u poslednje dve decenije. Gastrointestinalni tip ove infekcije se javlja veoma retko, i u njemu je želudac najčešće mesto infekcije, a slede ga kolon i ileum. Faktori rizika su nekontrolisani dijabetes melitus, upotreba kortikosteroida i transplantacija organa. Prikazujemo bolesnicu sa istorijom reumatoidnog artritisa koja je dobila gastrointestinalnu formu mukormikoze. Prema našim podacima, ovo je prvi takav slučaj opisan u literaturi. Prikaz bolesnika. Bolesnica sa reumatoidnim artritisom, stara 53 godine, primljena je u bolnicu zbog perzistentne dijareje. Fizičkim pregledom  ustanovljena je difuzna osetljivost stomaka na palpaciju, bez znakova meteorizma i peritonitisa. Labaratorijski nalazi su ukazali na sistemsku inflamaciju, tako da je uključena antibiotska terapija. Snimanjem kompjuterizovanom tomografijom nađeni su znaci inflamacije rektuma i levog kolona. Kolonoskopija je ukazivala na Kronovu bolest. Pored toga, bolesnica je razvila profuzno krvarenje iz rektuma i ubrzo je podvrgnuta hitnoj hirurškoj intervenciji. Izvršena je subtotalna kolektomija sa ileostomom i parcijalna gastrektomija. Nakon operacije, stanje bolesnice se naglo pogoršalo i umrla je od multiorganske disfunkcije. Patohistološkom analizom hirurškog materijala otkriven je hronični aktivni kolitis i opsežna nekroza želuca sa infiltracijom gustim mešovitim inflamatornim infiltratom i brojnim hifama, neseptiranim i razgranatim pod pravim uglom. Ustanovljena je mukormikoza, ali, na žalost, tek nekoliko dana nakon smrti bolesnice. Zaključak. Veoma je značajno skrenuti pažnju na ovu smrtonosnu infekciju, kako bi se postigla brza dijagnoza i uspešna terapija.

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Objavljeno
2022/09/21
Broj časopisa
Vol. 79 Br. 7 (2022): Vojnosanitetski pregled
Rubrika
Prikaz bolesnika