Tojima H, Tokudome T, Otsuka T
Department of Chest Medicine, Tokyo Rosai Hospital.
Nihon Kyobu Shikkan Gakkai Zasshi. 1997 Jan;35(1):100-5.
We describe a case of chronic pulmonary mucormycosis. The patient was a 44-year-old man with diabetes mellitus and alcoholic liver cirrhosis. He had been treated for pulmonary tuberculosis three years earlier and thin-walled cavities remained in the left upper lobe. He presented with coughing, sputum, and fever, and a chest radiograph and CT scan showed increased consolidation around the preexisting cavities in the left lung, along with a small round opacity in the right upper lobe. Transbronchial lung biopsy of the left upper lobe revealed pulmonary mucormycosis with necrosis. Treatment with amphotericin B for two months was not completely successful, particularly with regard to the lesion on the left, so surgery was done. A left upper lobectomy and a left S6 segmentectomy were successful, and the lesion in the right lung resolved after chemotherapy. Pathological examination showed that the resected lung had granulomas, infiltration of inflammatory cells, areas of necrosis, and a druse of Mucor in an abscess. We view this as a case of chronic necrotizing pulmonary mucormycosis.
我们描述了一例慢性肺毛霉菌病病例。患者为一名44岁男性,患有糖尿病和酒精性肝硬化。三年前他曾接受过肺结核治疗,左上叶仍残留薄壁空洞。他出现咳嗽、咳痰和发热症状,胸部X线片和CT扫描显示左肺原有空洞周围实变增加,同时右上叶有一个小圆形致密影。左上叶经支气管肺活检显示为伴有坏死的肺毛霉菌病。使用两性霉素B治疗两个月并不完全成功,尤其是左侧病变,因此进行了手术。左上叶切除术和左S6段切除术成功,右肺病变在化疗后消退。病理检查显示,切除的肺组织有肉芽肿、炎性细胞浸润、坏死区域以及脓肿内的毛霉菌菌丛。我们认为这是一例慢性坏死性肺毛霉菌病。