Department of Respiratory Medicine, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo, 108-0073, Japan.
Department of Thoracic Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
BMC Pulm Med. 2020 Nov 26;20(1):312. doi: 10.1186/s12890-020-01352-y.
Fungal infections are rarely reported as a complication of bronchial thermoplasty (BT) in patients without immunosuppressive comorbidity.
A 19-year-old woman college student was admitted to our hospital owing to uncontrolled severe asthma despite using the maximum dose of steroid inhalation. She experienced asthmatic attacks more frequently while cheerleading, which is an extracurricular activity. She received BT because she wanted to continue cheerleading. After the second BT session, she developed more sputum and cough. During the third session, white secretion and saccular bronchodilation appeared in the left lower bronchus. Aspergillus fumigatus was detected in the culture of the bronchial lavage sample, and saccular bronchodilation in the affected bronchus was observed on computed tomography (CT). Five months after the start of oral itraconazole, her subjective symptoms as well as her CT findings improved. Her asthma condition improved enough for the patient to continue cheerleading without exacerbation.
It is necessary to consider the possibility of respiratory tract infections including fungal infections after BT. Detailed observations of the entire bronchus and sample collection for microbial culture are highly recommended.
在没有免疫抑制合并症的患者中，支气管热成形术 (BT) 很少会引发真菌感染并发症。
一名 19 岁的女大学生，尽管使用了最大剂量的吸入性类固醇，但仍患有难以控制的严重哮喘，因此被收入我院。她在啦啦队等课外活动中哮喘发作更为频繁。她接受 BT 治疗是因为她想继续参加啦啦队。第二次 BT 治疗后，她的痰液和咳嗽增多。第三次治疗时，左肺下叶支气管出现白色分泌物和囊状支气管扩张。支气管灌洗液培养检测出烟曲霉，CT 显示受累支气管出现囊状支气管扩张。开始口服伊曲康唑治疗 5 个月后，她的主观症状和 CT 检查结果均有所改善。她的哮喘病情得到了足够的控制，可以继续参加啦啦队而不加重。
BT 后需要考虑包括真菌感染在内的呼吸道感染的可能性。强烈建议对整个支气管进行详细观察，并采集样本进行微生物培养。
