糖尿病患者中，（1,3）-β-D-葡聚糖阴性、白细胞升高且降钙素原升高伪装成重症肺炎，最终经支气管肺泡灌洗术培养确诊为侵袭性肺曲霉病：病例报告及文献复习
Negative (1,3)-β-D-glucan and Elevated White Blood Cells Combined Procalcitonin Masquerading as Severe Pneumonia Eventually Diagnosed as Invasive Pulmonary Aspergillosis Proven by Bronchoalveolar Lavage Fluid Culture in a Diabetes Patient: a Case Report and Literature Review.
作者信息
Ge Yan L, Zhang Qian, Wang Meng H, Li Li Q, Fu Ai S, Liu Cong H, Zhang Hai F, Li Wen Q, Chen Yi, Zhang Shuang, Hao Chen, Zhang Ci, Zhu Xiao Y
出版信息
Clin Lab. 2019 Aug 1;65(8). doi: 10.7754/Clin.Lab.2019.190135.
BACKGROUND
We report an invasive pulmonary aspergillosis (IPA) with negative (1,3)-β-D-glucan and dynamically elevated white blood cells combined with procalcitonin proven by bronchoalveolar lavage fluid (BALF) culture.
METHODS
Appropriate laboratory tests are carried out. Chest CTs were performed to assess the lungs. The cause of infection was determined using BALF culture.
RESULTS
Serum (1,3)-β-D-glucan was negative, white blood cells and procalcitonin were significantly higher than normal. The bronchoscopy revealed obvious necrotic detritus and pseudo membrane in the trachea, left and right main bronchi, and branches. BALF culture revealed the presence of Aspergillus.
CONCLUSIONS
Negative (1,3)-β-D-glucan is not safe to rule out invasive pulmonary aspergillosis. BALF culture is critical for IPA diagnosis.
背景
我们报告一例侵袭性肺曲霉病（IPA），其（1,3）-β-D-葡聚糖检测为阴性，白细胞及降钙素原动态升高，经支气管肺泡灌洗术（BALF）培养证实。
方法
进行了适当的实验室检查。行胸部CT评估肺部情况。通过BALF培养确定感染原因。
结果
血清（1,3）-β-D-葡聚糖为阴性，白细胞及降钙素原显著高于正常水平。支气管镜检查显示气管、左右主支气管及其分支有明显坏死碎屑及假膜。BALF培养发现曲霉菌存在。
结论
（1,3）-β-D-葡聚糖检测阴性不能排除侵袭性肺曲霉病。BALF培养对IPA诊断至关重要。
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