Xiang Hanxue, Zhang Ling, Yang Liu, Cai Miaotian, Ma Yingmin, Zhang Yulin
Department of Respiratory and Critical Care Medicine, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China.
Beijing Research Center for Respiratory Infectious Diseases, Beijing, China.
BMC Infect Dis. 2025 Jan 14;25(1):66. doi: 10.1186/s12879-025-10447-y.
Chronic pulmonary abscess usually results from bacterial or mycobacterium infection, but rarely from aspergillosis. Chronic pulmonary aspergillosis is usually found in a person with structural lung disease or immunocompromise. Here, we report a case of chronic lung abscess of aspergillosis without immunocompromise, structural lung diseases or even clinical symptoms.
A 43-year-old female was found a mass shadow with central liquid anechoic area in the apical posterior segment of the left upper lung lobe by chest computerized tomography for 1 month, but had no any systematic or respiratory complaints. The percutaneous abscess puncture was performed and 30 milliliters of yellow purulent fluid were aspirated from the liquid anechoic area. Then Aspergillus terreus was detected by both fluid culture and metagenomics next-generation sequencing. Interestingly, this patient had no history of tuberculosis or chronic pulmonary diseases. Other immunocompromised conditions were also denied through history inquest and laboratory tests. Ultimately, the catheterization and drainage of the lung abscess and 6 months of antifungal therapy with standard dose of voriconazole brought the woman a favorable outcome.
Aspergillus lung abscess can occasionally occur in a person without pre-existent lung cavity and immune suppression, which is prone to misdiagnosis because of the rarity and the symptom-free.
慢性肺脓肿通常由细菌或分枝杆菌感染引起,但很少由曲霉病导致。慢性肺曲霉病通常见于有结构性肺病或免疫功能低下的患者。在此,我们报告一例无免疫功能低下、结构性肺病甚至临床症状的慢性肺曲霉病肺脓肿病例。
一名43岁女性因胸部计算机断层扫描发现左上肺叶尖后段有一伴有中央液性无回声区的肿块阴影1个月,但无任何全身或呼吸道不适症状。进行了经皮脓肿穿刺,从液性无回声区抽出30毫升黄色脓性液体。随后通过液体培养和宏基因组学下一代测序检测到土曲霉。有趣的是,该患者无结核病史或慢性肺病病史。通过病史询问和实验室检查也排除了其他免疫功能低下情况。最终,肺脓肿置管引流及6个月标准剂量伏立康唑抗真菌治疗使该女性获得了良好预后。
曲霉性肺脓肿偶尔可发生于无既往肺空洞和免疫抑制的患者,因其罕见且无症状,故易被误诊。