Maeda T
Department of Internal Medicine, Yourou Central Hospital, Gifu, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1994 Feb;32(2):168-73.
A 63-year-old male was hospitalized due to persistent cough on August 19, 1991. He was suspected to have pulmonary tuberculosis based on the findings of chest roentgenograms. He was therefore given anti-tuberculous drugs and antibiotics as of the first hospital day. Approximately two months later, he developed high fever, and the infiltrative shadows on his chest roentgenograms worsened. Therefore, he was readmitted to our hospital on October 31, 1991. Despite the use of several antibiotics, his high fever persisted and the infiltrative shadows on chest roentgenography continued to worsen after admission. Although no pathogenic microorganisms were isolated, in spite of frequent sputum examinations, we strongly suspected pulmonary aspergillosis because serum precipitin antibody against aspergillus antigens was positive. Intravenous administration of miconazole was thus initiated and lead to reduction in the fever. The fever recurred but, after the start of miconazole inhalation, gradually diminished. Serum precipitin antibody subsequently became negative. We diagnosed this case as chronic necrotizing pulmonary aspergillosis based on the clinical course. It is often difficult to confirm the presence of aspergillus hyphae. Therefore, this disease should be suspected on the basis of serum precipitin antibody. In such cases, a therapeutic diagnosis should be attempted.
一名63岁男性因持续咳嗽于1991年8月19日住院。根据胸部X线检查结果，怀疑他患有肺结核。因此，从入院第一天起就给他使用了抗结核药物和抗生素。大约两个月后，他出现高热，胸部X线片上的浸润阴影加重。因此，他于1991年10月31日再次入住我院。尽管使用了几种抗生素，但他仍持续高热，入院后胸部X线检查显示浸润阴影继续加重。尽管多次痰检未分离出致病微生物，但由于抗曲霉抗原的血清沉淀素抗体呈阳性，我们强烈怀疑为肺曲霉病。于是开始静脉注射咪康唑，发热有所减轻。发热复发，但在开始吸入咪康唑后逐渐消退。血清沉淀素抗体随后转为阴性。根据临床病程，我们将该病例诊断为慢性坏死性肺曲霉病。通常很难证实曲霉菌丝的存在。因此，应根据血清沉淀素抗体怀疑该病。在这种情况下，应尝试进行治疗性诊断。
