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变应性支气管肺曲霉病继发肺血栓栓塞症一例报告

A case report of pulmonary thromboembolism following allergic bronchopulmonary aspergillosis.

作者信息

Pan Ying, Xu Feng, Ou-Yang Wei

机构信息

Department of Infectious Diseases, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.

出版信息

Medicine (Baltimore). 2020 Jan;99(2):e18692. doi: 10.1097/MD.0000000000018692.

Abstract

RATIONALE

Allergic bronchopulmonary aspergillosis (ABPA) complicated with pulmonary thromboembolism (PTE) is rare. This report describes a patient who was diagnosed with ABPA and soon developed PTE.

PATIENT CONCERNS

A 64-year-old man was diagnosed with ABPA in hospital for recurrent fever with cough. Two months later, the patient was readmitted to the hospital because of PTE.

DIAGNOSES

ABPA was diagnosed during the first hospitalization, and laboratory tests showed an increase in serum IgE and Aspergillus fumigatus-specific IgG. Sputum culture suggested A. fumigatus and high-resolution computed tomography (HRCT) showed inflammation of both lungs and central bronchiectasis. During the second hospitalization, the patient's chest angiography showed PTE.

INTERVENTIONS

The patient began treatment with antifungal drugs and corticosteroids, and was discharged from the hospital when his condition improved. Two months after discharge, the patient was treated with anticoagulant drugs due to PTE.

OUTCOMES

The patient got better after taking anticoagulant drugs and was discharged from the hospital. The patient appears for regular follow-up visits in our outpatient clinic every 2 months and is currently in good condition.

LESSONS

Patients with ABPA may be concurred with PTE. The risk of PTE in ABPA should be assessed in advance and preventive strategies also need to be taken beforehand. Pulmonary artery examination is necessary once it happened.

摘要

理论依据

变应性支气管肺曲霉病(ABPA)合并肺血栓栓塞症(PTE)较为罕见。本报告描述了一名被诊断为ABPA且很快发展为PTE的患者。

患者情况

一名64岁男性因反复发热伴咳嗽在医院被诊断为ABPA。两个月后,该患者因PTE再次入院。

诊断

首次住院期间诊断为ABPA,实验室检查显示血清IgE和烟曲霉特异性IgG升高。痰培养提示烟曲霉,高分辨率计算机断层扫描(HRCT)显示双肺炎症及中心性支气管扩张。第二次住院期间,患者的胸部血管造影显示PTE。

干预措施

患者开始接受抗真菌药物和糖皮质激素治疗,病情好转后出院。出院两个月后,患者因PTE接受抗凝药物治疗。

结果

患者服用抗凝药物后病情好转并出院。患者每2个月在我院门诊定期复诊,目前状况良好。

经验教训

ABPA患者可能并发PTE。应提前评估ABPA患者发生PTE的风险,并预先采取预防策略。一旦发生,肺动脉检查是必要的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ffe5/6959881/9567ab4e7289/medi-99-e18692-g001.jpg

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