Takata Seiichi, Yoshioka Yuichi, Naito Hiromichi, Kozuma Kazuo, Kinuwaki Etsuo
Department of Respiratory Medicine, Asahino General Hospital.
Nihon Kokyuki Gakkai Zasshi. 2011 Apr;49(4):315-20.
An 80-year-old woman with a history of rheumatoid arthritis and steroid diabetes had been given a diagnosis of multiple bilateral pulmonary cystic lesions 16 months previously, and these lesions were observed to gradually increase on follow-up. She presented with a fever of 38 degrees C, cough, and sputum for 2 weeks, and the pulmonary cystic lesions had enlarged, and therefore she was admitted. A chest X-ray film revealed multiple cystic lesions 4 cm in greatest dimension in both the left upper and middle lung fields, and chest computed tomography (CT) scans revealed that the lesions of the left S1+2 had niveau formation with a partially thickened wall. However, the lesions in the left S4 and S5 areas and the right S8 area had thin, smooth walls. Transbronchial lung biopsy of the left S4 lesion yielded granuloma formation and yeast-like fungus bodies within multinucleated giant cells, while bronchial lavage fluid culture showed cryptococcus neoformans. It is known that pulmonary cryptococcosis presents various images and histopathologic findings, according to the immune interactions between the fungus body and the host. We report a rare case that presented with multiple cryptococcal cystic lesions.
一名80岁女性，有类风湿关节炎和类固醇糖尿病病史，16个月前被诊断为双侧多发性肺囊性病变，随访观察发现这些病变逐渐增大。她出现发热38℃、咳嗽、咳痰2周，肺囊性病变增大，因此入院。胸部X线片显示左上和中肺野最大径为4 cm的多个囊性病变，胸部计算机断层扫描（CT）显示左S1+2区病变有液平形成，部分壁增厚。然而，左S4和S5区以及右S8区的病变壁薄且光滑。对左S4区病变进行经支气管肺活检，结果显示多核巨细胞内有肉芽肿形成和酵母样真菌体，而支气管灌洗液培养显示新型隐球菌。众所周知，根据真菌体与宿主之间的免疫相互作用，肺隐球菌病呈现出各种影像学和组织病理学表现。我们报告一例罕见的表现为多发性隐球菌囊性病变的病例。
