2024年 · 第104卷第36期

A 7-year-old male was diagnosed with Burkitt's lymphoma at Zhengzhou Children's Hospital of Henan Children's Hospital in July 2023. The affected sites include nasopharynx, sinus area, neck, bilateral axillary, abdominal cavity, skull, and maxillofacial bone. Chemotherapy was performed successively with cyclophosphamide + vincristine + bonisone, cyclophosphamide + vincristine + bonisone + daunorubicin + methotrexate and other regimens; Multiple intravenous infusions of red blood cells, platelets and use of granulocyte stimulating factor to manage the problem of bone marrow suppression after chemotherapy. PET/CT was re-examined in October 2023, and the glucose uptake (FDG) was significantly reduced compared with that before chemotherapy, and the extent of lesions was significantly reduced; In the same month, the child had repeated fever, with a fever peak of 39.4 ℃, accompanied by pain in both lower limbs, which was not severe. Physical examination: Multiple mung bean-sized nodules can be palpable subcutaneously and intramuscularly in both lower limbs, which are hard in texture, poor in activity, painful in pressing, and untouched in superficial lymph nodes; There were no yellowing stains, bleeding spots and rash on the whole body. The total number of white blood cells was 14.97×10 by blood routine⁹/L, C-reactive protein 103.16 mg/L, procalcitonin 0.134 μ g/L. Bilateral tibia and fibula MRI revealed bilateral tibial bone marrow cavities (Figure 1, coronal lipid pressure T₂WI, indicated by red arrows), subcutaneous and intramuscular layers of both calves (Figure 2, axial fat pressure T₂WI, indicated by red arrows) with multiple nodular hypertension, which showed nodular obvious enhancement after enhancement (Figure 3, T₁WI enhancement, indicated by red arrows). After multidisciplinary consultation, we considered fungal infections in soft tissues and bone marrow of both lower limbs, and recommended pathological biopsy. Incision and biopsy of subcutaneous lesions of right lower limb under general anesthesia, puncture of intratibial lesions and pathology and culture were performed, and the results showed Candida tropicalis infection. Later, a plain CT scan of the chest was performed, which showed multiple nodules in the upper lobes of both lungs (Figure 4, shown by white arrows), and fungal infection was considered. Second-generation sequencing of peripheral blood suggests that the sequence number of Candida tropicalis is 27. The clinical diagnosis was candida sepsis and sepsis, and anti-infective treatments such as meropenem, amphotericin B, caspofungin, linezolid, vancomycin and voriconazole were successively applied. The clinical symptoms of the children gradually improved, and the inflammatory indexes gradually tended to normal. After reexamination of MRI of both tibias and fibula, the abnormal signals in the original bone marrow cavity and surrounding soft tissues basically disappeared.