Ouchi Hiroshi, Fujita Masaki, Ikegame Satoshi, Inoshima Ichiro, Harada Eiji, Nakanishi Yoichi
Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan.
J Infect Chemother. 2007 Aug;13(4):258-62. doi: 10.1007/s10156-007-0524-9. Epub 2007 Aug 27.
A 63-year-old man was admitted to our hospital because he complained of fever and productive cough; this was associated with cavitary infiltrates on his chest X-ray. Although several antibiotics were given, his symptoms did not improve. Bronchofiberscope investigation yielded Aspergillus fumigatus; thus, he was diagnosed with chronic necrotizing pulmonary aspergillosis. Itraconazole, 200 mg/day, was given, and his symptoms and infiltrates on chest X-ray gradually improved. After 2 months of treatment, new infiltrates appeared on a chest X-ray. Antibacterial agents had also shown no effect, and voriconazole was substituted for itraconazole. However, the infiltrates progressed in spite of the voriconazole administration. We added micafungin to the voriconazole treatment. Both his symptoms and the infiltrates on chest X-rays improved. Because voriconazole is thought to be the most effective agent against Aspergillus spp., it is difficult to treat cases that are refractory to voriconazole. The treatment of this case provides invaluable information on how to treat pulmonary aspergillosis related to diseases other than hematologic malignancies.
一名63岁男性因发热和咳痰就诊于我院；胸部X线显示有空洞性浸润。尽管使用了多种抗生素，但其症状并未改善。支气管纤维镜检查发现烟曲霉；因此，他被诊断为慢性坏死性肺曲霉病。给予伊曲康唑200mg/天，其症状及胸部X线浸润逐渐改善。治疗2个月后，胸部X线出现新的浸润影。抗菌药物治疗无效，遂将伊曲康唑换为伏立康唑。然而，尽管使用了伏立康唑，浸润影仍进展。我们在伏立康唑治疗基础上加用米卡芬净。患者症状及胸部X线浸润均改善。由于伏立康唑被认为是抗曲霉属最有效的药物，因此治疗对伏立康唑难治的病例很困难。该病例的治疗为如何治疗非血液系统恶性肿瘤相关的肺曲霉病提供了宝贵信息。
