Nakamura Yutaro, Shirai Masahiro, Hayakawa Hiroshi, Nakano Yasukatsu, Fujita Kaoru, Suda Takafumi, Chida Kingo
Mycoses. 2008 Jan;51(1):86-8. doi: 10.1111/j.1439-0507.2007.01434.x.
We present a case of chronic necrotising pulmonary aspergillosis (CNPA) successfully diagnosed, treated and followed by ultrathin bronchoscope. A 68-year-old man was admitted to the hospital because of a cough and low-grade fever. A chest computerized tomography (CT) showed cavitary infiltrates in the superior segment of the left upper lobe. Bronchoscopic examination was performed using a 2.8-mm ultrathin bronchoscope, which could be inserted into the cavity lesion under direct vision. Biopsy specimens from a whitish intracavity lesion showed septate-branching hyphae and cultures of the cavital washing grew Aspergillus fumigatus. Using the ultrathin bronchoscope, we instilled amphotericin B into the cavity before oral itraconazole therapy. The patient showed clinical improvement with resolution of the cavitary infiltrates on CT findings. The whitish intracavity lesion had prominently disappeared after 18 months of therapy. An ultrathin bronchoscope is useful for treating and assessing cavity lesions as well as establishing a diagnosis for CNPA patients.
我们报告一例经超薄支气管镜成功诊断、治疗及随访的慢性坏死性肺曲霉病（CNPA）病例。一名68岁男性因咳嗽和低热入院。胸部计算机断层扫描（CT）显示左上叶尖段有空洞性浸润。使用2.8毫米超薄支气管镜进行支气管镜检查，可在直视下插入空洞病变。来自腔内白色病变的活检标本显示有分隔分支的菌丝，空洞灌洗培养出烟曲霉。在口服伊曲康唑治疗前，我们使用超薄支气管镜将两性霉素B注入空洞。患者临床症状改善，CT检查显示空洞性浸润消失。治疗18个月后，腔内白色病变明显消失。超薄支气管镜对于治疗和评估空洞病变以及确诊CNPA患者很有用。
