Chawke Liam J, Hunt Eoin B, Kennedy Marcus P, Murphy Desmond M
Department of Respiratory Medicine Cork University Hospital Cork Ireland.
Respirol Case Rep. 2017 Jun 1;5(4):e00243. doi: 10.1002/rcr2.243. eCollection 2017 Jul.
A 76-year-old male non-smoker presented to our institution with cough and haemoptysis. He had been treated for cavitatory pulmonary Mycobacterium tuberculosis of the right upper lobe 10 years previously. Chest radiograph and subsequent computed tomography (CT) of the chest demonstrated a right upper cavity containing a mass suspicious for mycetoma. Flexible bronchoscopy under conscious sedation demonstrated a mass obstructing the anterior segment of the right upper lobe. The abnormality was subsequently removed using a flexible endobronchial cryoprobe. Histopathological analysis demonstrated abundant fungal organisms morphologically consistent with Aspergillus species. Microbiological culture of the bronchoalveolar lavage (BAL) from the cavity isolated both Aspergillus fumigatus and Staphylococcus aureus. The patient was commenced on the anti-fungal drug posaconazole and received a course of flucloxacillin. Three months later, there was no endobronchial obstruction and lavage of the affected cavity again isolated Staphylococcus aureus without Aspergillus species. Repeat thoracic CT and flexible bronchoscopy demonstrated no further re-occurrence of the mycetoma at 3 months.
一名76岁男性非吸烟者因咳嗽和咯血前来我院就诊。他10年前曾因右上叶空洞性肺结核接受治疗。胸部X线片及随后的胸部计算机断层扫描（CT）显示右上叶有一个空洞，内有一个疑似曲菌球的肿块。在清醒镇静下进行的柔性支气管镜检查显示有一个肿块阻塞右上叶前段。随后使用柔性支气管内冷冻探头切除了该异常病变。组织病理学分析显示有大量形态上与曲霉菌属一致的真菌生物体。对空洞内支气管肺泡灌洗（BAL）液进行微生物培养，分离出烟曲霉和金黄色葡萄球菌。患者开始使用抗真菌药物泊沙康唑，并接受了一个疗程的氟氯西林治疗。三个月后，支气管内无阻塞，对患侧空洞进行灌洗，再次分离出金黄色葡萄球菌，未分离出曲霉菌种。重复胸部CT和柔性支气管镜检查显示3个月时曲菌球未再次出现。
