Hirano K, Saitoh T, Kadono K, Oose H, Watanabe S, Hasegawa S
Department of Internal Medicine, National Seiransou Hospital, Ibaraki, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1997 Apr;35(4):408-13.
An 82-year-old man with rheumatoid arthritis was admitted to the hospital because of bloody sputum, appetite loss, and a chest-radiographic abnormality. He had previously been treated with oral steroid therapy. The chest X-ray film showed an infiltrative shadow with airlucency in the right upper lung field. Sputum culture for fungi was negative, but a test for aspergillus antigen in serum was positive. Other clinical findings were also compatible with conversion of chronic necrotizing pulmonary aspergillosis to invasive pulmonary aspergillosis. The patient was successfully treated with a drip infusion of fulconazole. The patients condition was stable for several months, after which he died due to uncontrollable atrial flutter. Mild immunosuppression due to oral steroid therapy probably caused chronic necrotizing pulmonary aspergillosis in this case. The patient's general condition worsened after admission and invasive pulmonary aspergillosis developed. This case taught us that therapy for chronic necrotizing pulmonary aspergillosis should include management of the patient's general condition as well as treatment of the pulmonary lesions.
一名82岁的类风湿性关节炎男性因咯血、食欲减退和胸部X线异常入院。他此前接受过口服类固醇治疗。胸部X线片显示右上肺野有一个伴有透亮区的浸润性阴影。痰真菌培养阴性，但血清曲霉抗原检测呈阳性。其他临床发现也与慢性坏死性肺曲霉病转变为侵袭性肺曲霉病相符。该患者通过氟康唑静脉滴注成功治愈。患者病情稳定了几个月，之后因无法控制的心房扑动死亡。在本病例中，口服类固醇治疗导致的轻度免疫抑制可能引发了慢性坏死性肺曲霉病。患者入院后全身状况恶化并发展为侵袭性肺曲霉病。该病例提示，慢性坏死性肺曲霉病的治疗应包括患者全身状况的管理以及肺部病变的治疗。
