Yanagisawa Naoki, Takeshita Nozomi, Suganuma Akihiko, Imamura Akifumi, Ajisawa Atsushi, Negishi Masayoshi, Suzuki Tomokazu, Honma Misao
Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital.
Kansenshogaku Zasshi. 2007 Mar;81(2):200-5. doi: 10.11150/kansenshogakuzasshi1970.81.200.
A 45-year-old homosexual man with pneumocystis pneumonia and esophageal candidiasis tested positive in ELISA and Western blot analysis for HIV-1. His CD4+ T cell count was 43/microL and his HIV-RNA load was 250,000 copies/mL. He was treated with Trimetoprim-Sulfamethoxazole, Prednisolone and Fluconazole. Valganciclovir was added to treat CMV retinitis. During the clinical course, 21 days after admission, the patient presented with a temperature of 39 degrees C and blood analysis showed neutropenia. Cefepime and G-CSF were initiated, but new consolidation was observed in the upper left lobe in chest radiography. He underwent bronchoscopy and lavage culture was positive for Aspergillus fumigatus. Serum testing of galactomannan was also positive and pulmonary aspergillosis was diagnosed. The patient was initially treated with Micafungin but switched to Voriconazole when clinical symptoms worsened. An eventual clinical response was observed and pulmonary aspergillosis was controlled. Unfortunately, he died of sepsis due to MRSA 2 months later. Pulmonary aspergillosis is a devastating complication with poor prognosis in patients with HIV infection. Amphotericin-B has been the mainstay of pulmonary aspergillosis treatment, but reports indicate mortality exceeding 80%. Use of Voriconazole, a relatively new antifungal agent, may lower mortality with fewer adverse effects than conventional antifungal therapy.
一名45岁的同性恋男子，患有肺孢子菌肺炎和食管念珠菌病，ELISA和Western blot分析检测HIV-1呈阳性。他的CD4 + T细胞计数为43/微升，HIV-RNA载量为250,000拷贝/毫升。他接受了甲氧苄啶 - 磺胺甲恶唑、泼尼松龙和氟康唑治疗。加用缬更昔洛韦治疗巨细胞病毒性视网膜炎。在临床过程中，入院21天后，患者体温达到39摄氏度，血液分析显示中性粒细胞减少。开始使用头孢吡肟和粒细胞集落刺激因子，但胸部X线检查发现左上叶出现新的实变。他接受了支气管镜检查，灌洗培养曲霉菌呈阳性。半乳甘露聚糖血清检测也呈阳性，诊断为肺曲霉病。患者最初用米卡芬净治疗，但临床症状恶化时改用伏立康唑。最终观察到临床反应，肺曲霉病得到控制。不幸的是，2个月后他死于耐甲氧西林金黄色葡萄球菌败血症。肺曲霉病是HIV感染患者中一种具有毁灭性的并发症，预后不良。两性霉素B一直是肺曲霉病治疗的主要药物，但报告显示死亡率超过80%。使用伏立康唑这种相对较新的抗真菌药物，可能会降低死亡率，且不良反应比传统抗真菌治疗更少。
