A 49-year-old man with acute myeloid leukemia who had been admitted to the hospital for induction chemotherapy was evaluated for prolonged neutropenic fever. On physical examination, crackles were identified at the lung bases. Computed tomography of the chest is shown. Empiric treatment with amphotericin B was started. After 2 weeks of treatment, repeat CT of the chest is shown. What is the most likely diagnosis?
一位49岁男性，因急性髓系白血病住院接受诱导化疗，因持续中性粒细胞减少伴发热而接受评估。体格检查发现肺底有湿啰音。胸部CT结果如图所示。开始经验性使用两性霉素B治疗。治疗2周后复查胸部CT，结果如图所示。最可能的诊断是什么？
A. Cytomegalovirus pneumonia巨细胞病毒肺炎
B. Leukemic pulmonary infiltrates白血病肺浸润
C. Pulmonary bacterial abscesses肺脓肿
D. Pulmonary mucormycosis肺毛霉病
E. Pulmonary tuberculosis肺结核
答案解析：
胸部CT显示圆形实变影，中心呈磨玻璃样密度，周围环绕环形实变，这种表现称为反晕征（reversed halo sign），可见于侵袭性真菌感染。随即开始给予两性霉素B经验性治疗，但因中性粒细胞恢复，复查CT时病灶反而加重。最终通过对切除肺组织的病理学检查和PCR检测肺组织标本，确认病原体为微小根毛霉（Rhizomucor pusillus），因此诊断为肺毛霉病（Pulmonary mucormycosis）。
正确答案：D
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