Ikari Tomoo, Nagai Katsura, Ohe Masashi, Harada Toshiyuki, Akiyama Yasushi
Department of Respiratory Medicine, Center for Respiratory Diseases, JCHO Hokkaido Hospital, Japan.
Department of Connective Tissue Disease, JCHO Hokkaido Hospital, Japan.
Respir Med Case Rep. 2017 Apr 19;21:124-128. doi: 10.1016/j.rmcr.2017.04.017. eCollection 2017.
A 67-year-old female with rheumatoid arthritis and asthma-chronic obstructive pulmonary disease overlap syndrome was admitted for drug-induced hypersensitivity syndrome (DIHS) caused by salazosulfapyridine. Human herpes virus 6 (HHV-6) variant B was strongly positive on peripheral blood. Multiple cavities with ground grass opacities rapidly emerged predominantly in the upper and middle lobes. She was diagnosed with invasive pulmonary aspergillosis (IPA), and was treated successfully with antifungal agents. Therapeutic systemic corticosteroids, emphysematous change in the lungs, and the worsening of the patient's general condition due to DIHS were considered major contributing factor leading to IPA. HHV-6 reactivation could have an effect on clinical course of IPA. Cavities with halo sign would provide an early clue to IPA in non-neutropenic and immunosuppressive patients.
一名67岁女性，患有类风湿性关节炎和哮喘-慢性阻塞性肺疾病重叠综合征，因柳氮磺胺吡啶引起的药物性超敏反应综合征（DIHS）入院。外周血中人类疱疹病毒6型（HHV-6）B亚型呈强阳性。主要在上叶和中叶迅速出现多个伴有磨玻璃影的空洞。她被诊断为侵袭性肺曲霉病（IPA），并接受抗真菌药物成功治疗。治疗性全身糖皮质激素、肺部的肺气肿改变以及DIHS导致患者全身状况恶化被认为是导致IPA的主要因素。HHV-6重新激活可能会影响IPA的临床病程。有晕征的空洞可为非中性粒细胞减少和免疫抑制患者的IPA提供早期线索。
