Wright S H, Czaja A J, Katz R S, Soloway R D
Am J Gastroenterol. 1980 Nov;74(5):428-32.
Four patients with severe chronic active liver disease, treated with 30-200 mg. of prednisone daily for one-half month to seven months because of lack of response to smaller doses, developed systemic mycosis. Presentation was variable, consisting of cryptococcal meningitis, cryptococcal pneumonia, aspergillus cerebral vasculitis and disseminated histoplasmosis originating from a histoplasma pneumonia. None of 114 patients in the Mayo Clinic trials on conventional treatment for at least six months, but only one of 25 patients (4%) on high dose prednisone, developed systemic mycosis. Low dose prednisone or its equivalent can be maintained to control hepatic inflammation during vigorous antifungal therapy without jeopardizing cure of the fungal infection. We conclude that systemic mycosis is infrequently associated with corticosteroid therapy for severe chronic active liver disease but can occur on high dose regimens as a subtle, progressively debilitating and potentially fatal complication that justifies prompt recognition and aggressive treatment with amphotericin-B alone or in combination with 5-fluorocytosine.
4例严重慢性活动性肝病患者，因对小剂量治疗无反应，每日服用30 - 200毫克泼尼松，持续半月至7个月，发生了系统性霉菌感染。临床表现各异，包括隐球菌性脑膜炎、隐球菌性肺炎、曲霉菌性脑血管炎以及由组织胞浆菌性肺炎引起的播散性组织胞浆菌病。梅奥诊所对114例患者进行至少6个月的常规治疗，无一例发生系统性霉菌感染，但在25例接受高剂量泼尼松治疗的患者中，仅1例（4%）发生了系统性霉菌感染。在积极的抗真菌治疗期间，可维持低剂量泼尼松或其等效药物以控制肝脏炎症，而不会危及真菌感染的治愈。我们得出结论，系统性霉菌感染与用于严重慢性活动性肝病的皮质类固醇治疗很少相关，但在高剂量方案中可能会发生，作为一种隐匿、逐渐使人衰弱且可能致命的并发症，这证明应及时识别并用两性霉素B单独或与5 -氟胞嘧啶联合进行积极治疗。
