Anzai Fumio, Yamamoto Akito, Tannai Noriyuki, Abe Hideki, Tsuchiya Kayoko, Kusajima Kenji, Shimoide Hisao, Nunomura Maki
Department of Respiratory Medicine, Tachikawa Sougo Hospital.
Nihon Kokyuki Gakkai Zasshi. 2009 Jul;47(7):608-13.
A 62-year-old man had felt cold-like symptoms for 2 months. He visited a clinic for a health check in late July 1998 and chest X-ray film showed an infiltrative shadow in the left middle and lower lung fields. Next day he had a fever of 38.3 degrees C and felt breathless. Six days thereafter he had a cough, thick head and felt fatigue. Chest X-ray films showed other infiltrative shadows in the bilateral upper lung fields. He worked in a race track and was exposed to pigeons and seabirds at that time. Culture of sputum grew Cryptococcus neoformans. He was admitted and was treated with intravenous antifungal drugs. Cerebrospinal fluid examination revealed positive Indian ink stain for C. neoformans. The CD4 + T-lymphocyte count and CD8 + T-lymphocyte count were 143.4 cells/mm3 and 1288.8 cells/mm3 respectively, but without HIV infection. Cryptococcal pneumonia and meningitis with Idiopathic CD4 + T-lymphocytopenia was diagnosed. After induction therapy, the symptoms improved but abnormal shadows remained on chest X-ray films. Maintenance therapy has been continued at doses of 200 mg/day of fluconazole for 10 years. He has had no symptoms, but the abnormal X-ray shadow has persisted and the CD4 count has remained low during the same period.
一名62岁男性出现类似感冒症状2个月。1998年7月下旬他前往一家诊所进行健康检查，胸部X线片显示左肺中下野有浸润性阴影。次日，他发热至38.3摄氏度，并有气促感。此后6天，他出现咳嗽、头痛加重及乏力感。胸部X线片显示双侧上肺野出现其他浸润性阴影。他在赛马场工作，当时接触过鸽子和海鸟。痰培养长出新型隐球菌。他入院后接受了静脉抗真菌药物治疗。脑脊液检查显示新型隐球菌墨汁染色阳性。CD4 + T淋巴细胞计数和CD8 + T淋巴细胞计数分别为143.4个细胞/mm3和1288.8个细胞/mm3，但无HIV感染。诊断为新型隐球菌肺炎和脑膜炎伴特发性CD4 + T淋巴细胞减少症。诱导治疗后，症状有所改善，但胸部X线片上仍有异常阴影。已持续进行维持治疗，氟康唑剂量为每日200毫克，持续了10年。他没有症状，但异常的X线阴影持续存在，同期CD4计数一直较低。
