Tokui Kotaro, Kawagishi Yukio, Inomata Minehiko, Taka Chihiro, Okazawa Seisuke, Yamada Toru, Miwa Toshiro, Hayashi Ryuji, Matsui Shoko, Takano Yasuo, Tobe Kazuyuki
Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
J Med Case Rep. 2012 Aug 31;6:270. doi: 10.1186/1752-1947-6-270.
Chronic necrotizing pulmonary aspergillosis usually occurs in mildly immune-compromised hosts or those with underlying pulmonary disease. The radiographic pattern of chronic necrotizing pulmonary aspergillosis is typically a progressive upper lobe cavitary infiltrate with pleural thickening. We report here an atypical case of chronic necrotizing pulmonary aspergillosis mimicking lung cancer, which developed into a disseminated fatal disease in an older woman with no comorbidity.
An 80-year-old Japanese woman was referred to our hospital for a chest roentgenogram abnormality. Repeated fiber-optic bronchoscopy could not confirm any definite diagnosis, and she refused further examinations. Considering the roentgenogram findings and her age, she was followed-up as a suspected case of lung cancer without any treatment. Then, 10 months later, she complained of visual disturbance and was admitted to our department of ophthalmology. She was diagnosed as having endophthalmitis. After treatment with corticosteroids for 20 days, she developed acute encephalitis and died four weeks later. Autopsy revealed dissemination of Aspergillus hyphae throughout her body, including her brain.
In older patients, even if they do not have any comorbidity, chronic necrotizing pulmonary aspergillosis should be added to the differential diagnosis of solitary pulmonary lesions in a chest roentgenogram.
慢性坏死性肺曲霉病通常发生在轻度免疫功能低下的宿主或患有基础肺部疾病的患者中。慢性坏死性肺曲霉病的影像学表现通常为进行性上叶空洞性浸润伴胸膜增厚。我们在此报告一例非典型的慢性坏死性肺曲霉病病例，其酷似肺癌，在一名无合并症的老年女性中发展为播散性致命疾病。
一名80岁的日本女性因胸部X线片异常被转诊至我院。反复的纤维支气管镜检查未能确诊，且她拒绝进一步检查。考虑到X线片表现及她的年龄，她被作为疑似肺癌病例进行随访，未接受任何治疗。然后，10个月后，她主诉视力障碍，被收治入我院眼科。她被诊断为眼内炎。用皮质类固醇治疗20天后，她发生急性脑炎，四周后死亡。尸检显示曲霉菌丝在她全身播散，包括脑部。
在老年患者中，即使没有任何合并症，慢性坏死性肺曲霉病也应列入胸部X线片上孤立性肺部病变的鉴别诊断中。
