Majima Suguru, Okachi Shotaro, Asano Motoyo, Wakahara Keiko, Hashimoto Naozumi, Sato Mitsuo, Ishigami Masatoshi, Hasegawa Yoshinori
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan.
Department of Respiratory Medicine and Allergology, Kariya Toyota General Hospital, Japan.
Intern Med. 2018 Aug 15;57(16):2371-2375. doi: 10.2169/internalmedicine.9673-17. Epub 2018 Mar 30.
Invasive tracheobronchial aspergillosis (ITBA), a rare form of invasive pulmonary Aspergillus infection (IPA), is predominantly confined to the tracheobronchial tree. We herein report a case of ITBA with severe necrotic pseudomembrane in a 57-year-old woman with fulminant hepatitis and hemophagocytic syndrome. Bronchoscopic findings revealed a widespread pseudomembranous formation of the trachea and bronchi. Aspergillus fumigatus was cultured from bronchial lavage fluid, and the histological findings of an endobronchial biopsy revealed necrosis and invasive hyphae. Although she responded to antifungal treatment, she ultimately died of a septic shock with Burkholderia cepacia 57 days after admission.
侵袭性气管支气管曲霉病（ITBA）是侵袭性肺曲霉感染（IPA）的一种罕见形式，主要局限于气管支气管树。我们在此报告一例57岁患有暴发性肝炎和噬血细胞综合征的女性患者发生的伴有严重坏死性假膜的ITBA病例。支气管镜检查结果显示气管和支气管广泛形成假膜。从支气管灌洗液中培养出烟曲霉，支气管内活检的组织学结果显示坏死和侵袭性菌丝。尽管她对抗真菌治疗有反应，但最终在入院57天后死于洋葱伯克霍尔德菌引起的感染性休克。
