Hitsuda Y, Kawasaki Y, Igishi T, Ikeda T, Yamamoto Y, Sasaki T
Third Department of Internal Medicine, Tottori University, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1995 Dec;33(12):1469-74.
A 67-year-old man with pulmonary emphysema was admitted to the hospital because of left back pain. Chest roentgenography revealed an infiltrate in the left upper lobe, with cavitation, Mycetoma-like shadows were seen in the cavities about 3 weeks later, and a test for the precipitating antibody to Aspergillus fumigatus was positive. Chronic necrotizing pulmonary aspergillosis (CNPA) was diagnosed, and fluconazole was given. A chest roentgenogram taken 4 weeks later showed resolution of both the mycetoma-like shadows and much of the infiltrate. Systemic immunosuppression was highly unlikely: the patient had not been undergoing corticosteroid therapy, and had no predisposing conditions, such as a chronic debilitating illness or diabetes mellitus. In that sense, this case is similar to another reported recently, in which CNPA was associated with chronic obstructive pulmonary disease in an immunocompentent patient.
一名67岁的肺气肿男性因左背部疼痛入院。胸部X线检查显示左上叶有浸润影，伴有空洞形成。约3周后在空洞内可见类似曲菌球的阴影，烟曲霉沉淀抗体检测呈阳性。诊断为慢性坏死性肺曲霉病（CNPA），给予氟康唑治疗。4周后拍摄的胸部X线片显示类似曲菌球的阴影及大部分浸润影均已消退。该患者极不可能存在全身免疫抑制：他未曾接受过皮质类固醇治疗，也没有诸如慢性消耗性疾病或糖尿病等易患因素。从这一点来看，本病例与最近报道的另一例相似，后者是一名免疫功能正常的患者，其CNPA与慢性阻塞性肺疾病相关。
