Maruyama Takaya, Takagi Takehiro, Yuda Hisamichi
Department of Internal Medicine, Kinan General Hospital.
Nihon Kokyuki Gakkai Zasshi. 2005 Feb;43(2):94-8.
The patient was a 73-year-old female who visited a physician with a chief complaint of fever, and was diagnosed with pneumonia. Ampicillin/sulbactam was administered, but ineffective, and the patient was referred to our hospital. In addition to severe inflammatory findings, cavity lesions were observed in the right upper lobe on plain chest X-ray and thoracic CT. Since Aspergillus fumigatus was cultured in bronchoalveolar lavage, a definite diagnosis of pulmonary aspergillosis was made. Intravenous administration of micafungin was initiated, but severe inflammatory findings persisted, and infiltrative shadows rapidly expanded. Oral itraconazole was concomitantly administered, and clinical symptoms and findings slowly improved. The plasma trough levels of micafungin, itraconazole, and hydroxyitraconazole were higher than the minimal inhibitory concentrations for the etiologic fungus, A. fumigatus, throughout the treatment period. No adverse events of the concomitant treatment were observed. Combination of the two antifungal agents may be effective for intractable pulmonary aspergillosis.
患者为一名73岁女性，因发热为主诉就诊于医生，被诊断为肺炎。给予氨苄西林/舒巴坦治疗，但无效，随后患者被转诊至我院。除了严重的炎症表现外，胸部X线平片和胸部CT显示右上叶有空洞病变。由于在支气管肺泡灌洗中培养出烟曲霉，故确诊为肺曲霉病。开始静脉注射米卡芬净，但严重的炎症表现持续存在，浸润阴影迅速扩大。同时口服伊曲康唑，临床症状和表现逐渐改善。在整个治疗期间，米卡芬净、伊曲康唑和羟基伊曲康唑的血浆谷浓度均高于致病真菌烟曲霉的最低抑菌浓度。未观察到联合治疗的不良事件。两种抗真菌药物联合使用可能对难治性肺曲霉病有效。
