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白色念珠菌诱发的嗜酸性粒细胞增多综合征伴肺部浸润一例报告

[A case report of pulmonary infiltration with eosinophilia syndrome induced by Candida albicans].

作者信息

Miyagawa H, Yokota S, Kajimoto K, Makimoto K, Sato K, Nabe M, Tada S, Kimura I

机构信息

Second Department of Internal Medicine, Okayama University Medical School.

出版信息

Arerugi. 1992 Jan;41(1):49-55.

PMID:1554325
Abstract

A sixty six-year-old female who had been treated for bronchial asthma for about 25 years was admitted to the hospital with complaints of episodes of dyspnea, eosinophilia and infiltrative shadows in the chest X-ray film. An infiltrative shadow appeared to move from the left to the right lung field and finally formed a shadow of atelectasis in the middle field of the right lung. A sputum culture showed only Candida albicans. Allergic and immunologic examination revealed high IgE serum levels with specific IgE against Candida albicans in high titer, and Aspergillus fumigatus in low titer. The precipitating antibody was shown only against Candida antigen. Additionally, the blastogenic response to Candida antigen was high in comparison with other fungal antigens including Aspergillus fumigatus. The clinical features and laboratory findings of this patient were found to satisfy Rosenberg's criteria for allergic bronchopulmonary aspergillosis (ABPA), except for the existence of Candida albicans in place of Aspergillus species as the causative antigen. The pathogenesis of PIE syndrome has been studied and various allergic mechanisms against many antigens reported. In this patient Candida albicans could be playing the crucial role in the formation of PIE syndrome, which might be best described as allergic bronchopulmonary candidiasis (ABPC).

摘要

一名66岁女性,患支气管哮喘约25年,因呼吸困难发作、嗜酸性粒细胞增多及胸部X线片出现浸润阴影而入院。浸润阴影似乎从左肺野移至右肺野,最终在右肺中叶形成肺不张阴影。痰培养仅显示白色念珠菌。过敏和免疫学检查显示血清IgE水平升高,针对白色念珠菌的特异性IgE滴度高,针对烟曲霉的特异性IgE滴度低。仅对念珠菌抗原显示沉淀抗体。此外,与包括烟曲霉在内的其他真菌抗原相比,对念珠菌抗原的增殖反应较高。除了以白色念珠菌代替曲霉菌种作为致病抗原外,该患者的临床特征和实验室检查结果符合罗森伯格变应性支气管肺曲霉菌病(ABPA)的标准。对PIE综合征的发病机制进行了研究,并报道了针对多种抗原的各种过敏机制。在该患者中,白色念珠菌可能在PIE综合征的形成中起关键作用,这可能最好描述为变应性支气管肺念珠菌病(ABPC)。

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