Kim Doh Hyung, Lee Jae Hyun, Kim Byung Ha, Choi Eun Kyung, Park Jae Seok, Kim Keun Youl, Choi Young Hi, Myong Na Hye, Lee Kye Young
Dankook University Medical Center, Division of Pulmonary Medicine, 16-5 Anseo-dong, Chonan, Republic of Korea.
Korean J Intern Med. 2002 Jun;17(2):138-42. doi: 10.3904/kjim.2002.17.2.138.
Chronic necrotizing pulmonary aspergillosis (CNPA) is an unusual form of pulmonary aspergillosis arising in the setting of mildly immune compromised state or altered local defense system. CNPA rarely shows histological findings mimicking bronchocentric granulomatosis (BCG), which is characterized by peribronchiolar granulomatous destruction. We describe a case representing CNPA with elements of BCG. A-64 year-old woman was admitted because of atypical pneumonia with multi-focal variable sized consolidations and cavitary lesions on high-resolution computed tomography (HRCT). The open lung biopsy specimen showed large areas of necrotizing pneumonia with some scattered aspergillus hyphae within the lung parenchyma. Some terminal bronchioles were found to be destroyed and were replaced by peribronchiolar granulomatous inflammation. There was no evidence of angioinvasion by aspergillus or aspergillous emboli. Despite vigorous antifungal agent and steroid treatment, she died of acute airway obstruction by bronchial casts on the thirty-fourth hospital day.
慢性坏死性肺曲霉病（CNPA）是一种不常见的肺曲霉病形式，发生于轻度免疫功能受损状态或局部防御系统改变的情况下。CNPA很少表现出类似支气管中心性肉芽肿病（BCG）的组织学特征，BCG的特征是细支气管周围肉芽肿性破坏。我们描述了一例具有BCG特征的CNPA病例。一名64岁女性因非典型肺炎入院，高分辨率计算机断层扫描（HRCT）显示多灶性大小不一的实变和空洞性病变。开胸肺活检标本显示大片坏死性肺炎，肺实质内有一些散在的曲霉菌丝。发现一些终末细支气管被破坏，并被细支气管周围肉芽肿性炎症所取代。没有曲霉菌血管侵袭或曲霉菌栓子的证据。尽管进行了积极的抗真菌药物和类固醇治疗，但她在住院第34天死于支气管铸型导致的急性气道阻塞。
