Ichiyasu Hidenori, Yamamura Akiko, Honda Mitsuko, Okamoto Shinichiro, Tsumori Kaori, Okamoto Tatsuya, Sato Keizo, Matsumoto Mitsuhiro, Kohrogi Hirotsugu
Department of Respiratory Medicine, Faculty of Medical and Pharmaceutical Sciences, Kumamoto University.
Nihon Kokyuki Gakkai Zasshi. 2006 Oct;44(10):754-60.
A 74-year-old woman was treated with steroid and cyclosporine A for hypersensitivity pneumonia. To examine the causes of general fatigue and increased levels of beta-D glucan in serum, she was admitted to our hospital. Chest computed tomography (CT) scan revealed nodular opacity with a well-defined margin in the right S1. 67Ga scintigraphy image showed high uptake in the left thigh and CT showed circularly enhanced lesions in the thigh. An ultrasonography-guided needle aspiration and biopsy of the muscle abscess allowed isolation of Aspergillus fumigatus and evidence of necrotic tissues around the granuloma formation. We therefore diagnosed invasive aspergillosis. Because of the poor response to initial therapy with micafungin and itraconazole for 4 weeks, we treated her with voliconazole (VCZ). Spectacular regression of lung lesions and muscle abscesses was rapidly achieved. Furthermore, the high level of beta-D glucan in serum decreased gradually. This case suggests that administration of VCZ can be recommended for deep seated mycoses.
一名74岁女性因过敏性肺炎接受类固醇和环孢素A治疗。为检查全身疲劳及血清β-D葡聚糖水平升高的原因，她入住我院。胸部计算机断层扫描（CT）显示右肺上叶前段（S1）有边界清晰的结节状阴影。67Ga闪烁显像显示左大腿摄取增高，CT显示大腿有环形强化病灶。超声引导下对肌肉脓肿进行针吸活检，分离出烟曲霉，并发现肉芽肿形成周围有坏死组织。因此，我们诊断为侵袭性曲霉病。由于最初使用米卡芬净和伊曲康唑治疗4周效果不佳，我们改用伏立康唑（VCZ）对她进行治疗。肺部病灶和肌肉脓肿迅速显著消退。此外，血清中高水平的β-D葡聚糖也逐渐下降。该病例提示，对于深部真菌病可推荐使用VCZ治疗。
