Yamashita E, Kume H, Sato H, Shionoya S, Ishikawa C, Kida Y, Okudaira M, Mochizuki M, Funaoka M, Murase S
Department of Hematology, School of Medicine, Kitasato University.
Kansenshogaku Zasshi. 1993 Jan;67(1):85-91. doi: 10.11150/kansenshogakuzasshi1970.67.85.
The frequency of a visceral mycosis grows definitely higher with an immunocompromised host. Invasive fungal infection can be controlled by means of development of early diagnosis and antifungal therapy. In these types of cases, it is difficult to establish an antemortem diagnosis of invasive pulmonary aspergillosis and most of them were diagnosed postmortem. A patient was diagnosed as aspergillosis from the clinical and serological features. This patient underwent successful therapy during remission induction therapy of acute myelocytic leukemia (AML). A 26-year-old male was admitted to our hospital because of leukocytosis with a diagnosis of AML made by reviewing peripheral blood smears and bone marrow aspirate. After remission induction therapy, he was still febrile in spite of treatment with a broad spectrum antibiotics and empiric therapy of fluconazole. Unfortunately shadowing appeared on the chest radiograph and aspergillus antigen was detected from the serum and the sputum. Consequently, the patient who suffered from invasive pulmonary aspergillosis was diagnosed and treated with intravenous amphotericin B and flucytosine. The radiological shadow improved but AML relapsed, therefore, remission induction therapy of AML was started again but he died of sepsis caused MRSA. In the postmortem histopathological examination the lung tissues, the hyphae could not be confirmed while, in immunohistochemical examinations of the lesion at the left S8, aspergillus antigens were detected around the small necrotic lesions and in the polymorphologic giant cells. We emphasize that invasive pulmonary aspergillosis is very difficult to diagnose whereas active examinations and clinical early diagnosis may lead to more effective therapy and the prognosis.
在内科真菌感染中，免疫功能低下宿主的内脏霉菌感染发生率明显更高。侵袭性真菌感染可通过早期诊断和抗真菌治疗来控制。在这类病例中，生前很难确诊侵袭性肺曲霉病，大多数病例是在死后才确诊的。有一名患者根据临床和血清学特征被诊断为曲霉病。该患者在急性髓细胞白血病（AML）缓解诱导治疗期间接受了成功的治疗。一名26岁男性因白细胞增多症入院，通过外周血涂片和骨髓穿刺检查诊断为AML。缓解诱导治疗后，尽管使用了广谱抗生素和氟康唑经验性治疗，他仍持续发热。不幸的是，胸部X光片出现阴影，血清和痰液中检测到曲霉抗原。因此，该侵袭性肺曲霉病患者被诊断出来，并接受了静脉注射两性霉素B和氟胞嘧啶治疗。放射学阴影有所改善，但AML复发，因此再次开始AML缓解诱导治疗，但他死于耐甲氧西林金黄色葡萄球菌引起的败血症。在死后组织病理学检查中，肺组织未发现菌丝，但在左S8病变的免疫组织化学检查中，在小坏死灶周围和多形性巨细胞中检测到曲霉抗原。我们强调，侵袭性肺曲霉病很难诊断，而积极检查和临床早期诊断可能会带来更有效的治疗和更好的预后。
