Duggal Rajan, Rajwanshi Arvind, Gupta Nalini, Lal Anupam, Singhal Manphool
Department of Cytopathology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Diagn Cytopathol. 2010 Apr;38(4):294-6. doi: 10.1002/dc.21198.
Tuberculous and fungal infections are among the non-neoplastic lesions of the lung, in which fine-needle aspiration cytology (FNAC) has proven to be a useful technique in both immunocompromised and immunocompetent patients. The presence of polymicrobial infection in a renal transplant recipient is documented in the literature, but has rarely been diagnosed on cytology. We report a case of concomitant pulmonary cryptococcosis, aspergillosis, and tuberculosis in a renal transplant recipient diagnosed on FNAC.A 50-year-old renal transplant recipient, asymptomatic for 3 year, presented with intermittent low-grade fever associated with cough, expectoration, and a newly developed cavitatory lesion in the left lung on chest X-ray. Computed tomography-guided FNAC performed on the lung lesion showed fungal profiles with septate hyphae and acute-angled branching consistent with morphology of Aspergillus. In addition, numerous yeast forms of cryptococcus and a few acid-fast mycobacterial tubercle bacilli were seen.Guided FNAC is a useful and reliable technique for the diagnosis of pulmonary infection. One should always keep in mind the possibility of polymicrobial infections especially inimmunocompromised patients.
结核和真菌感染属于肺部非肿瘤性病变，细针穿刺细胞学检查（FNAC）已被证明在免疫功能低下和免疫功能正常的患者中都是一种有用的技术。文献记载了肾移植受者存在多种微生物感染的情况，但通过细胞学诊断的情况很少见。我们报告了一例通过FNAC诊断出的肾移植受者同时患有肺隐球菌病、曲霉菌病和结核病的病例。一名50岁的肾移植受者，3年来无症状，出现间歇性低热，伴有咳嗽、咳痰，胸部X线显示左肺新出现一个空洞性病变。对肺部病变进行计算机断层扫描引导下的FNAC检查，结果显示真菌形态为有隔菌丝和锐角分支，符合曲霉菌的形态。此外，还发现了大量隐球菌酵母形式以及少量抗酸分枝杆菌结核杆菌。引导下的FNAC是诊断肺部感染的一种有用且可靠的技术。尤其对于免疫功能低下的患者，应始终牢记存在多种微生物感染的可能性。
