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[一例变应性支气管肺曲霉病所致心肌病病例]

[A case of cardiomyopathy due to allergic bronchopulmonary aspergillosis].

作者信息

Matsuda S, Yokota E, Furugo I, Ikematsu W, Imamura Y, Matsumoto I, Ogata Y, Ashihara T, Fukuyama T, Daimaru Y

机构信息

Department of Internal Medicine, Matsuyama Red Cross Hospital.

出版信息

Kokyu To Junkan. 1991 Jul;39(7):703-7.

PMID:1896665
Abstract

We report a rare occurrence of cardiomyopathy associated with allergic bronchopulmonary aspergillosis (ABPA). A 49-year-old man with a history of bronchial asthma was referred to the Matsuyama Red Cross Hospital for evaluation of the abnormal shadow on his chest X-ray. Laboratory examination showed blood eosinophilia and marked elevation of serum IgE concentration and IgE antibody to A fumigatus. The immediate and late skin reactivities to A fumigatus antigen were both positive. The diagnosis of ABPA was made. Treatment using prednisolone was effective in ameliorating the symptoms. However, he was admitted again due to dyspnea, edema and anorexia 6 months later. Chest X-ray, ECG, UCG and scintigraphy suggested severe cardiac failure. The clinical diagnosis of hypertrophic cardiomyopathy, and the pathohistological diagnosis of endomyocardial fibrosis were made by cardiac catheterization and biopsy of endocardium. Retrospectively, cardiomegaly had gradually increased during the past several months while peripheral blood eosinophilia had continued. All these data strongly suggested that eosinophilia due to ABPA might cause severe cardiac damage.

摘要

我们报告了一例罕见的与变应性支气管肺曲霉病(ABPA)相关的心肌病。一名有支气管哮喘病史的49岁男性因胸部X线片上的异常阴影被转诊至松山红十字医院进行评估。实验室检查显示血液嗜酸性粒细胞增多,血清IgE浓度及针对烟曲霉的IgE抗体显著升高。对烟曲霉抗原的即刻和迟发性皮肤反应均为阳性。确诊为ABPA。使用泼尼松龙治疗可有效改善症状。然而,6个月后他因呼吸困难、水肿和厌食再次入院。胸部X线、心电图、超声心动图和闪烁扫描提示严重心力衰竭。通过心导管检查和心内膜活检做出肥厚型心肌病的临床诊断及心内膜纤维化的病理组织学诊断。回顾过去,在过去几个月中心脏肿大逐渐加重,同时外周血嗜酸性粒细胞持续增多。所有这些数据强烈提示ABPA所致的嗜酸性粒细胞增多可能会导致严重的心脏损害。

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