Kai Yoshiro, Kataoka Ryosuke, Suzuki Kentaro, Takano Masato, Muro Shigeo
Department of Respiratory Medicine, Minami-Nara General Medical Center, 8-1 Fukugami, Oyodo-cho, Yoshino-gun, Nara, 638-8551, Japan.
Department of Diagnostic Pathology, Minami-Nara General Medical Center, 8-1 Fukugami, Oyodo-cho, Yoshino-gun, Nara, 638-8551, Japan.
Respir Med Case Rep. 2023 Jun 19;45:101887. doi: 10.1016/j.rmcr.2023.101887. eCollection 2023.
Allergic bronchopulmonary aspergillosis (ABPA) is a lung disorder caused by a hypersensitivity reaction to antigens of the . Recently, allergic bronchopulmonary mycosis (ABPM) caused by fungi other than but with the same symptoms has been described. ABPM commonly affects patients with allergic diseases including bronchial asthma. ABPM is characterized by radiographic appearance, with the most common findings being proximal bronchiectasis and signs of mucoid impaction. However, the differentiation of ABPM is often necessary to enable accurate diagnosis of lung cancer. A 73-year-old man visited the outpatient clinic with symptoms of exertional dyspnea. He was diagnosed with ABPM due to suspicious bronchiectasis and mucoid impaction observed in computed tomography (CT) of his chest. After 3 months, he visited our hospital with continued exertional dyspnea and suspicion of a possible tumor in his lung. Marked eosinophilia and high-attenuation mucus impaction were not taken into consideration as diagnosis was conducted as per clinical diagnostic criteria for ABPA/ABPM. We hereby report a case of lung cancer in a patient initially evaluated for suspected ABPM of the right lung. The diagnosis of lung cancer was established using bronchoscopy. If any definitive diagnosis is not achieved by following the clinical diagnostic criteria for ABPM, physicians should achieve a histological diagnosis by performing a prompt bronchoscopy.
变应性支气管肺曲霉菌病（ABPA）是一种由对曲霉菌抗原的超敏反应引起的肺部疾病。最近，已描述了由除曲霉菌外的其他真菌引起但具有相同症状的变应性支气管肺真菌病（ABPM）。ABPM通常影响包括支气管哮喘在内的变应性疾病患者。ABPM的特征在于影像学表现，最常见的表现是近端支气管扩张和黏液嵌塞征象。然而，为了准确诊断肺癌，ABPM的鉴别往往是必要的。一名73岁男性因劳力性呼吸困难症状就诊于门诊。由于在其胸部计算机断层扫描（CT）中观察到可疑的支气管扩张和黏液嵌塞，他被诊断为ABPM。3个月后，他因持续的劳力性呼吸困难和怀疑肺部可能有肿瘤前来我院就诊。由于是根据ABPA/ABPM的临床诊断标准进行诊断，因此未将明显的嗜酸性粒细胞增多和高密度黏液嵌塞考虑在内。我们在此报告一例最初因疑似右肺ABPM而接受评估的患者发生肺癌的病例。通过支气管镜检查确诊为肺癌。如果遵循ABPM的临床诊断标准未得出任何明确诊断，医生应通过及时进行支气管镜检查来获得组织学诊断。
