Ahmad M, Weinstein A J, Hughes J A, Cosgrove D E
Am J Med. 1981 Apr;70(4):887-90. doi: 10.1016/0002-9343(81)90549-0.
A patient with granulomatous mediastinitis due to Aspergillus flavus is described. A 22 year old black man presented with cough, fever and a right hilar mass. Mediastinal biopsies revealed granulomatous fibrosing mediastinitis with fungal elements compatible with aspergillus species. A flavus was isolated on culture of this material and later from sputum and bronchial washings. Studies of the patient's immune status revealed normal humoral and cellular immunity. No underlying neoplasm was found. The patient was treated with amphotericin B and 5-fluorocytosine but esophageal and superior vena caval compression developed and he died. This is the first reported case of granulomatous mediastinitis due to A. flavus in a patient whose immune responses were not suppressed (nonimmunosuppressed patient). Infection with Aspergillus species should be considered in the differential diagnosis of granulomatous mediastinitis.
本文描述了一名因黄曲霉导致肉芽肿性纵隔炎的患者。一名22岁黑人男性，出现咳嗽、发热及右肺门肿块。纵隔活检显示为肉芽肿性纤维性纵隔炎，伴有与曲霉菌属相符的真菌成分。从该组织培养物中分离出黄曲霉，随后又从痰液和支气管灌洗物中分离出该菌。对患者免疫状态的研究显示其体液免疫和细胞免疫均正常。未发现潜在肿瘤。患者接受两性霉素B和5-氟胞嘧啶治疗，但出现食管和上腔静脉受压，最终死亡。这是首例关于免疫反应未受抑制（非免疫抑制患者）的患者因黄曲霉导致肉芽肿性纵隔炎的报道病例。在肉芽肿性纵隔炎的鉴别诊断中应考虑曲霉菌属感染。
