van Hoorn J H L, Hendriks J J E, Dompeling E, Jöbsis Q
Academisch Ziekenhuis, afd. Kindergeneeskunde, Postbus 5800, 6202 AZ, Maastricht.
Ned Tijdschr Geneeskd. 2005 Mar 12;149(11):594-7.
Three children developed allergic bronchopulmonary aspergillosis (ABPA) as a complication of either asthma or cystic fibrosis (CF). The first patient was a 14-year-old boy with CF who presented with an episode of haemoptysis and a decrease in lung function. He was initially treated with intravenous antibiotics but there was no improvement of his lung function. After starting prednisone-itraconazole his condition improved substantially. The second patient was a 16-year-old girl with CF complicated by ABPA. She was treated for 2 years with prednisone-itraconazole. Although the symptoms worsened when the prednisone dosage was gradually reduced, her growth retardation and increased weight decided us to stop prednisone treatment. Two years later, her CF was once again complicated by ABPA. The third patientwas a 16-year-old boy with asthma who had initially been treated for an asthma exacerbation. In retrospect, the cause of his pulmonary exacerbation was probably an ABPA episode. These cases illustrate how important but also how difficult the early diagnosis of ABPA is, and the dilemmas faced in treatment to prevent the fibrotic end stage.
三名儿童因哮喘或囊性纤维化（CF）并发症而患上变应性支气管肺曲霉病（ABPA）。首例患者是一名14岁患有CF的男孩，出现咯血和肺功能下降。他最初接受静脉抗生素治疗，但肺功能无改善。开始使用泼尼松-伊曲康唑治疗后，他的病情显著改善。第二例患者是一名16岁患有CF且并发ABPA的女孩。她接受泼尼松-伊曲康唑治疗2年。尽管泼尼松剂量逐渐减少时症状恶化，但她的生长发育迟缓及体重增加促使我们停止泼尼松治疗。两年后，她的CF再次并发ABPA。第三例患者是一名16岁患有哮喘的男孩，最初因哮喘急性发作接受治疗。回顾来看，其肺部急性发作的原因可能是一次ABPA发作。这些病例说明ABPA早期诊断既重要又困难，以及在预防纤维化终末期的治疗中面临的困境。
