Sato M, Saku N, Takeda A, Suzuki N, Saito T, Minato N, Saito K, Kano S
Department of Clinical Immunology, Jichi Medical School, Tochigi.
Ryumachi. 1993 Feb;33(1):56-62.
A case of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) associated with pulmonary cryptococcosis which was successfully treated with fluconazole (FCZ) and flucytosine (5-FC) is described. A 63-year-old woman who had been treated with steroid for SLE and low dose methotrexate (MTX) for RA was admitted to Jichi Medical School Hospital because of abnormal shadow in the chest X-ray film. Physical examination revealed no abnormality. A chest CT film showed multiple nodular shadows localized in the right lower lobe. An ultrasonically guided trans-cutaneous lung biopsy performed on 10th hospital day established a diagnosis of pulmonary cryptococcosis. Following the treatment with FCZ and 5-FC for a month, her abnormal lung shadows improved and serum cryptococcal antigen level was decreased. A survey of the literature from 1955 to 1990 revealed 44 cases of SLE associated with cryptococcosis in Japan, in addition to our case, most of whom were on corticosteroid therapy. The majority of patients were young women, representing the usual population of patients with SLE. 34 of these patients had cryptococcal meningitis; 22, pulmonary cryptococcosis; 6, sepsis; 6 cutaneous cryptococcosis. Twenty patients died. Deep fungal infections should be considered whenever patients with SLE have fever of unknown origin, diffuse pulmonary infiltrates, or unexplained CNS symptoms.
本文描述了一例系统性红斑狼疮（SLE）和类风湿关节炎（RA）合并肺隐球菌病的病例，该病例经氟康唑（FCZ）和氟胞嘧啶（5-FC）成功治疗。一名63岁女性，因SLE接受类固醇治疗，因RA接受低剂量甲氨蝶呤（MTX）治疗，因胸部X光片出现异常阴影入住吉城医学院医院。体格检查未发现异常。胸部CT片显示右下叶有多个结节状阴影。入院第10天行超声引导下经皮肺活检，确诊为肺隐球菌病。经FCZ和5-FC治疗一个月后，其肺部异常阴影改善，血清隐球菌抗原水平下降。对1955年至1990年的文献调查显示，在日本，除我们的病例外，有44例SLE合并隐球菌病，其中大多数患者正在接受皮质类固醇治疗。大多数患者为年轻女性，这是SLE患者的常见人群。这些患者中，34例患有隐球菌性脑膜炎；22例患有肺隐球菌病；6例患有败血症；6例患有皮肤隐球菌病。20例患者死亡。当SLE患者出现不明原因发热、弥漫性肺部浸润或不明原因的中枢神经系统症状时，应考虑深部真菌感染。
