Fan Xiao-Yun, Wang Wei-Min, Yan Xue-Bo, Wang Cong-Hui, Liu Rong-Yu
Department of Pulmonology Medicine, Anhui Geriatric Institute, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, PR China.
Cent Eur J Immunol. 2015;40(1):117-21. doi: 10.5114/ceji.2015.50844. Epub 2015 Apr 22.
Invasive pulmonary aspergillosis (IPA) is difficult to diagnose because it requires histopathology and tissue culture, as well as due to its rapid progression. Invasive pulmonary aspergillosis is the primary cause of pulmonary mycosis in China, which can occur in patients with neutrophil deficiency, leukaemia or lymphoma, malignant tumours, or chronic obstructive pulmonary disease with long-term corticosteroid use or bacterial exacerbations. Such fungal infections can lead to disseminated disease and death within weeks, and the mortality rate for untreated invasive aspergillosis is high. Therefore, increased awareness of invasive aspergillosis in non-traditional hosts is warranted due to the high mortality rate experienced by patients with this disease. Invasive pulmonary aspergillosis has become a principal cause of life-threatening infections in immunocompromised patients. Invasive aspergillosis frequently involves the lung parenchyma and is infrequently accompanied by soft tissue lesions. We present an unusual case of a patient with agranulocytosis that was caused by methimazole that was given to control his hyperthyroidism, and IPA that was accompanied by unusual maxillofacial soft tissue swelling that required treatment with voriconazole. Upon follow-up 11 months later, a chest computed tomography scan (CT) revealed that most lesions had been completely absorbed. Moreover, his maxillofacial ulcers had become encrusted, and the soft tissue swelling had subsided.
侵袭性肺曲霉病(IPA)难以诊断,因为其诊断需要组织病理学检查和组织培养,且病情进展迅速。侵袭性肺曲霉病是中国肺部真菌病的主要病因,可发生于中性粒细胞缺乏、白血病或淋巴瘤、恶性肿瘤患者,或长期使用糖皮质激素或细菌感染加重的慢性阻塞性肺疾病患者。此类真菌感染可在数周内导致播散性疾病和死亡,未经治疗的侵袭性曲霉病死亡率很高。因此,鉴于该病患者的高死亡率,有必要提高对非传统宿主中侵袭性曲霉病的认识。侵袭性肺曲霉病已成为免疫功能低下患者危及生命感染的主要原因。侵袭性曲霉病常累及肺实质,很少伴有软组织病变。我们报告一例罕见病例,患者因服用甲巯咪唑控制甲状腺功能亢进导致粒细胞缺乏,并患有侵袭性肺曲霉病,伴有不寻常的颌面软组织肿胀,需用伏立康唑治疗。11个月后的随访胸部计算机断层扫描(CT)显示,大多数病灶已完全吸收。此外,他的颌面溃疡已结痂,软组织肿胀也已消退。