Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
Med Mycol. 2012 Nov;50(8):890-6. doi: 10.3109/13693786.2012.682320. Epub 2012 May 7.
A rare case of allergic bronchopulmonary mycosis (ABPM), caused by Alternaria alternata, is reported in an immunocompetent resident of Delhi. Her complaints included a generalized, urticarial skin rash and occasional pain in the right lower chest. Her differential count showed eosinophils, 22%; absolute eosinophil count (AEC), 2400 cells/μl; and total IgE, 4007 IU/ml. The computerised tomogram (CT) scan of her thorax showed an enhancing lesion with surrounding ground glass haziness in the right lower lobe. Histopathologic examination of the resected lung revealed a necrotizing granulomatous inflammation, parenchymal infiltration by eosinophils, lymphocytes, neutrophils, plasma cells and some exudative bronchiolitis suggestive of ABPM. Observation of KOH wet mounts of repeat sputum and BAL samples demonstrated the presence of septate, brownish hyphae and cultures of these specimens yielded A. alternata (identified by sequencing of the ITS region). Her serum showed a three-fold higher specific IgE to A. alternata antigens than control levels, and the type I cutaneous hypersensitivity response to antigens of A. alternata was strongly positive. She was treated successfully with oral glucocorticoids and itraconazole. To our knowledge, ABPM due to Alternaria alternata has not been reported previously.
报告一例罕见的变应性支气管肺曲霉病（ABPM），由链格孢菌引起，发生于德里的一位免疫功能正常的居民。她的症状包括全身性荨麻疹样皮疹和偶尔右下胸痛。她的外周血分类计数显示嗜酸性粒细胞为 22%；绝对嗜酸性粒细胞计数（AEC）为 2400 个/μl；总 IgE 为 4007 IU/ml。胸部计算机断层扫描（CT）显示右下叶有一个增强病变，周围有磨玻璃混浊。切除肺组织的组织病理学检查显示坏死性肉芽肿性炎症，嗜酸性粒细胞、淋巴细胞、中性粒细胞、浆细胞浸润肺实质，以及一些渗出性细支气管炎，提示 ABPM。重复痰和 BAL 样本的 KOH 湿片观察显示存在分隔、棕褐色菌丝，这些标本的培养物产生链格孢菌（通过 ITS 区测序鉴定）。她的血清对链格孢菌抗原的特异性 IgE 水平是对照水平的三倍，对链格孢菌抗原的 I 型皮肤超敏反应呈强阳性。她成功地接受了口服糖皮质激素和伊曲康唑治疗。据我们所知，以前没有报道过由链格孢菌引起的 ABPM。
