Kim Da Sol, Jeong Jae Seok, Kim So Ri, Jin Gong Yong, Chung Myoung Ja, Lee Yong Chul
From the Department of Internal Medicine, Research Center for Pulmonary Disorders (DSK, JSJ, SRK, YCL); Department of Radiology (GYJ); and Department of Pathology (MJC), Chonbuk National University Medical School, Deokjin-gu, Jeonju, South Korea.
Medicine (Baltimore). 2015 Aug;94(34):e1434. doi: 10.1097/MD.0000000000001434.
Aspergillus tracheobronchitis (ATB) represents a rare disease entity accounting for 3.5% to 5.0% of cases of invasive aspergillosis. Particularly, mass-forming ATB is extremely rare, and clinical reports are limited. Given that the patency of the trachea and bronchi are essential for maintaining sufficient airflow, a central airway mass originating from an Aspergillus infection is likely to be associated with severe clinical manifestations and fatal outcomes. Although several therapeutic options for ATB have been suggested, including medication and airway interventions, the optimal choice of treatment in diverse clinical conditions remains under discussion.We report a case of ATB that initially manifested as severe dyspnea and total atelectasis of the left lung in a patient with newly detected diabetes.Radiographic study, bronchoscopy, and pathologic findings of the lesion revealed mass-forming type of ATB.Interestingly, our patient's symptoms dramatically resolved with voriconazole without further invasive intervention.This clinical experience highlights the beneficial role of voriconazole in the treatment of rare and potentially fatal cases of ATB.
曲霉性气管支气管炎（ATB）是一种罕见的疾病实体，占侵袭性曲霉病病例的3.5%至5.0%。特别是，形成肿块的ATB极为罕见，临床报告有限。鉴于气管和支气管的通畅对于维持足够的气流至关重要，源自曲霉感染的中央气道肿块可能与严重的临床表现和致命后果相关。尽管已提出多种ATB治疗方案，包括药物治疗和气道干预，但不同临床情况下的最佳治疗选择仍在讨论中。我们报告一例ATB病例，该病例最初表现为一名新诊断为糖尿病患者的严重呼吸困难和左肺完全肺不张。病变的影像学研究、支气管镜检查和病理结果显示为形成肿块型ATB。有趣的是，我们的患者在未进行进一步侵入性干预的情况下，使用伏立康唑后症状显著缓解。这一临床经验突出了伏立康唑在治疗罕见且可能致命的ATB病例中的有益作用。
