Marks W H, Florence L, Lieberman J, Chapman P, Howard D, Roberts P, Perkinson D
Organ Transplant Program, Swedish Medical Center, Seattle, Washington 98104, USA.
Transplantation. 1996 Jun 27;61(12):1771-4. doi: 10.1097/00007890-199606270-00018.
Invasive pulmonary aspergillosis (IPA) is often a lethal entity in transplant recipients (up to 90%). We report the successful treatment of a case of IPA in a renal transplant recipient whose only risk for exposure was habitual marijuana smoking. Although marijuana smoking has been linked to the development of IPA in patients immunosuppressed for a variety of reasons, this case is the first report involving a solid organ transplant recipient. The patient's clinical course and treatment are described and the literature is reviewed with respect to environmental and patient risk factors. In this case, IPA was associated with the patient's heavy usage of marijuana during the immediate posttransplant period. Treatment was successful and included the experimental amphotericin product amphotericin B colloidal dispersion. Contemporaneous exposure to a large amount of inocula of Aspergillus within 30 days of receiving high doses of steroids appeared to be the most important factor that predisposed this patient to IPA. Transplant recipients should be specifically proscribed from marijuana use during periods of high steroid administration.
侵袭性肺曲霉病（IPA）在移植受者中往往是一种致命疾病（死亡率高达90%）。我们报告了一例肾移植受者IPA的成功治疗病例，该患者唯一的暴露风险是习惯性吸食大麻。尽管吸食大麻与因各种原因免疫抑制的患者发生IPA有关，但该病例是首例涉及实体器官移植受者的报告。描述了患者的临床病程和治疗情况，并就环境和患者风险因素对文献进行了综述。在该病例中，IPA与患者移植后即刻大量吸食大麻有关。治疗取得成功，包括使用试验性两性霉素产品两性霉素B胶体分散液。在接受高剂量类固醇治疗后30天内同时接触大量曲霉菌接种物似乎是该患者易患IPA的最重要因素。在高剂量使用类固醇期间，应特别禁止移植受者使用大麻。
