Acar Ali, Oncül Oral, Cavuşlu Saban, Okutan Oğuzhan, Kartaloğlu Zafer
Gülhane Askeri Tip Akademisi Haydarpaşa Eğitim Hastanesi, Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji Servisi, Istanbul, Turkey.
Turkiye Parazitol Derg. 2009;33(3):239-41.
In this study we present a patient with Loeffler's syndrome caused by Ascaris lumbricoides who presented with the clinical findings of community-acquired pneumonia (CAP). Our patient, who was twenty-five years old, and who had had symptoms such as coughing, expectorating, dyspnea and fever for approximately ten days, was hospitalized. We auscultated polyphonic rhonchuses at the both hemithoraxes. A chest X-ray revealed bilateral lower zone patch consolidation. Acute bacterial community acquired pneumonia (CAP) was diagnosed due to these findings and empirical antibiotic treatment was begun. Repeated sputum Gram stains were negative, and both sputum and blood cultures were sterile. A sputum smear was negative for acid-fast bacilli. The patient's fever and respiratory complaint did not respond to the empirical antibiotics therapy. During the course of advanced investigations, we measured peripheric eosinophilia, and high levels of total Eo and total IgE, and observed Ascaris lumbricoides eggs during stool examination. The patient was given a diagnosis of Loeffler's syndrome. Thereupon the patient was treated successfully with one dose of albendazol 400 mg. In conclusion, we suggest that Loeffler's syndrome must be considered early in the differential diagnosis for CAP when peripheric eosinophilia is seen in patients if they live in an endemic area for parasitic disease.
在本研究中，我们报告了一例由蛔虫引起的吕弗勒综合征患者，该患者表现出社区获得性肺炎（CAP）的临床症状。我们的患者为25岁，出现咳嗽、咳痰、呼吸困难和发热等症状约10天，随后住院治疗。我们在双肺听诊到多音性啰音。胸部X线显示双侧下叶斑片状实变。基于这些发现诊断为急性细菌性社区获得性肺炎（CAP），并开始经验性抗生素治疗。多次痰涂片革兰氏染色均为阴性，痰培养和血培养均无菌。痰涂片抗酸杆菌阴性。患者的发热和呼吸道症状对经验性抗生素治疗无反应。在进一步检查过程中，我们检测到外周血嗜酸性粒细胞增多、总嗜酸性粒细胞（Eo）和总免疫球蛋白E（IgE）水平升高，并在粪便检查中发现蛔虫卵。该患者被诊断为吕弗勒综合征。随后，患者接受一剂400毫克阿苯达唑治疗，治疗成功。总之，我们建议，如果患者生活在寄生虫病流行地区，出现外周血嗜酸性粒细胞增多时，在CAP的鉴别诊断中应尽早考虑吕弗勒综合征。
