Mahmood Nader, Azam Hamad, Ali M Imran, Khan M Anees
Pulmonary Fellow, St. Joseph's Regional Medical Center, Pulmonary Division, Paterson, NJ.
Clin Med Insights Case Rep. 2011;4:63-8. doi: 10.4137/CCRep.S8020. Epub 2011 Nov 9.
Hydatid disease is rare in the United States. Rarely the hydatid cyst can become infected with mycotic organisms, such as Aspergillus. We describe a young male who presents with clinical features of suppurative lung abscess whose workup diagnosed hydatid cyst complicated by Aspergillus co-infection.
A 27-year-old Peruvian male was hospitalized because of fever, chills, and productive cough of three months' duration. Clinical features were consistent with a suppurative lung abscess. Significant findings included leukocytosis with eosinophilia and a chest x-ray showing a large lingular lobe thick-walled cavity with a wavy irregular fluid level. The patient ultimately underwent surgical resection of the lingular lobe. Examination of the surgical specimen revealed the cavity to be a hydatid cyst. Histologic examination of the cyst wall showed intense inflammation and several septate hyphae of Aspergillus species. The patient recovered fully and has remained in good health.
A thick-walled cavity and a wavy meniscus constitute unusual features for an ordinary pyogenic lung abscess and suggests other possibilities. Endogenous cases of hydatid disease are uncommon in the United States, with the majority of cases occurring in immigrants. There are few published case reports describing incidental findings of Aspergillus in a hydatid cyst. The rare occurrence of such a condition can lead to a delay in diagnosis and treatment.
在美国，包虫病较为罕见。包虫囊肿极少会被真菌病原体感染，如曲霉菌。我们描述了一名年轻男性，其表现出化脓性肺脓肿的临床特征，经检查诊断为包虫囊肿并发曲霉菌共感染。
一名27岁的秘鲁男性因持续三个月的发热、寒战和咳痰而住院。临床特征与化脓性肺脓肿相符。重要发现包括白细胞增多伴嗜酸性粒细胞增多，胸部X线显示舌叶有一个大的厚壁空洞，伴有波浪状不规则液平。患者最终接受了舌叶手术切除。手术标本检查显示该空洞为包虫囊肿。囊肿壁的组织学检查显示有强烈炎症以及曲霉菌属的几个有隔菌丝。患者完全康复，至今保持健康。
厚壁空洞和波浪状半月板样表现是普通化脓性肺脓肿的不寻常特征，提示有其他可能性。在美国，内源性包虫病病例并不常见，大多数病例发生在移民中。很少有已发表的病例报告描述包虫囊肿中曲霉菌的偶然发现。这种情况的罕见发生可能导致诊断和治疗的延迟。
