Tanigawa Motoaki, Kimura Miho, Ichioka Maresuke, Saito Kimimasa
Division of Respiratory Diseases, Department of Medicine, Yamada Red Cross Hospital, 810, Takabuku, Misonomura, Watarai-gun, Mie, Japan.
Nihon Kokyuki Gakkai Zasshi. 2004 Mar;42(3):272-6.
In this case, a 65-year-old man complained of fever and productive cough while being treated for diabetes mellitus at the outpatient clinic. His chest CT scan revealed multiple infiltrative lesions in both the right and left lower pulmonary lobes. He was therefore given an antibiotic on suspicion of having bacterial pneumonia, and he also received nutritional instruction in relation to diabetes mellitus, and remission resulted. However, he could not maintain sufficient glycemic control thereafter, and his pulmonary lesions persisted. Because his lesions changed into cavitied multiple nodular lesions, as seen on a chest CT scan, a transbronchial lung biopsy was performed. Histopathological examination of the biopsy specimen demonstrated Cryptococcus organisms, and the Cryptococcus antigen titer was high, which led to a diagnosis of pulmonary cryptococcosis. After oral treatment with fluconazole for 1 year and 4 months, only a small nodule in the right lower lobe and a funicular lesion in the left lower lobe remained on a chest CT scan, and the patient had neither subjective symptoms nor evidence of inflammation, although he still had a positive antigen titer for Cryptococcus. Thus, the treatment was terminated. Improvement of the clinical symptoms and of the laboratory and radiological findings demonstrated the therapeutic efficacy of this treatment.
在该病例中，一名65岁男性在门诊治疗糖尿病时出现发热和咳痰。其胸部CT扫描显示左右下肺叶有多个浸润性病变。因此，怀疑他患有细菌性肺炎，给他使用了抗生素，同时他也接受了与糖尿病相关的营养指导，病情得到缓解。然而，此后他无法维持足够的血糖控制，肺部病变持续存在。由于胸部CT扫描显示其病变转变为多发空洞结节性病变，遂进行了经支气管肺活检。活检标本的组织病理学检查发现隐球菌，且隐球菌抗原滴度很高，从而诊断为肺隐球菌病。口服氟康唑治疗1年零4个月后，胸部CT扫描显示右下叶仅残留一个小结节，左下叶有一条索状病变，患者既无主观症状，也无炎症迹象，尽管其隐球菌抗原滴度仍为阳性。于是，治疗终止。临床症状以及实验室和影像学检查结果的改善证明了该治疗方法的疗效。
