Yamakawa Hideaki, Yoshida Masahiro, Morikawa Noriyuki, Fujimoto Shota, Ishikawa Takeo, Sano Koji, Nishiwaki Kaichi, Takagi Masamichi, Hayashi Masahiro, Kuwano Kazuyoshi, Aiba Keisuke
Department of Internal Medicine, Division of Respiratory Medicine, Jikei University School of Medicine, Kashiwa Hospital, Japan.
Intern Med. 2014;53(12):1391-5. doi: 10.2169/internalmedicine.53.1860. Epub 2014 Jun 15.
We herein report the case of a 68-year-old man with a history of allogeneic hematopoietic stem cell transplantation for acute myelocytic leukemia in whom graft-versus-host disease (GVHD) developed in the gastrointestinal tract and liver five months after transplantation. In that same period, chest computed tomography showed infiltration in both upper lungs. We performed bronchoscopy to clarify the GVHD and pulmonary infection. Nocardia nova was identified in the bronchoalveolar lavage fluid, and we diagnosed the patient as having pulmonary nocardiosis. Because the differential diagnosis is important for the medical management of GVHD and pulmonary infection, performing bronchoscopy is essential for making an appropriate and rapid diagnosis.
我们在此报告一例68岁男性患者，其有急性髓细胞白血病异基因造血干细胞移植史，移植后5个月出现胃肠道和肝脏移植物抗宿主病（GVHD）。同一时期，胸部计算机断层扫描显示双上肺浸润。我们进行了支气管镜检查以明确GVHD和肺部感染。在支气管肺泡灌洗液中发现了新星诺卡菌，我们诊断该患者患有肺诺卡菌病。由于鉴别诊断对于GVHD和肺部感染的医疗管理很重要，因此进行支气管镜检查对于做出适当和快速的诊断至关重要。
