Kaplan J, Johns C J
Johns Hopkins Med J. 1979 Oct;145(4):157-61.
The course and prognosis of all patients with mycetomas in the setting of pulmonary sarcoidosis from 1960 to 1978 were reviewed. Twelve patients were identified. All patients were managed conservatively without surgery or antifungal agents. Three patients died; however, only one death could be attributed to the presence of a mycetoma and all deaths were associated with severe pulmonary insufficiency. Episodes of both major and minor hemoptysis were managed successfully with supportive therapy alone in the remaining nine patients. Survival after the diagnosis of a mycetoma was 10-14 years in three patients, 5-7 years in three patients and 3-4 years in three patients. All nine surviving patients have required corticosteroids for control of their underlying sarcoidosis. Extracavitary invasive disease due to Aspergillus organisms was not seen in this group. In the setting of chronic pulmonary sarcoidosis with mycetoma formation, fatal hemoptysis is infrequent and episodes of hemorrhage may be safely managed with supportive medical therapy alone.
回顾了1960年至1978年间所有患有肺结节病合并足菌肿患者的病程及预后情况。共确定了12例患者。所有患者均采用保守治疗，未进行手术或使用抗真菌药物。3例患者死亡；然而，仅有1例死亡可归因于足菌肿的存在，且所有死亡均与严重的肺功能不全相关。其余9例患者的大咯血和小咯血发作仅通过支持治疗即成功得到控制。3例患者在诊断足菌肿后的存活时间为10 - 14年，3例为5 - 7年，3例为3 - 4年。所有9例存活患者均需要使用皮质类固醇来控制其潜在的结节病。该组中未发现曲霉菌引起的腔外侵袭性疾病。在慢性肺结节病合并足菌肿形成的情况下，致命性咯血并不常见，出血发作仅通过支持性药物治疗即可安全处理。
