Taira M, Katsura H, Kadoriku C, Hashimoto I, Sakai N, Chiyotani A, Yamawaki I
Department of Pulmonary Medicine, Seirei Hamamatsu Hospital, Shizuoka, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1997 Sep;35(9):991-5.
A 64-year-old woman with a history of old tuberculosis, had a fungus ball shadow with meniscus sign in the upper right lung field on a chest X-ray film in 1991. Based on the chest X-ray findings, pulmonary aspergilloma was suspected. Because the size of the intracavitary fungus ball increased, the patient was treated with itraconazole over one year in 1995, but there was no improvement. One month later, she was admitted because of fever, hemoptysis and productive cough, and chest X-ray showed an enlargement of intracavitary mass and infiltrative shadow in the right lung. Chronic necrotizing aspergillosis was diagnosed on the basis of her clinical and radiographic features, and positive serological test. Although itraconazol and amphotericin B were given, cavity and intracavitary fungus ball shadow kept growing. Combination therapy of antifungal drugs and ulinastatin markedly improved symptoms and resulted in complete disappearance of the fungus ball on chest CT scan.
一名64岁有陈旧性肺结核病史的女性，1991年胸部X线片显示右上肺野有一个伴有新月征的真菌球阴影。根据胸部X线表现，怀疑为肺曲菌球。由于腔内真菌球大小增加，1995年患者接受伊曲康唑治疗一年，但无改善。一个月后，她因发热、咯血和咳痰入院，胸部X线显示右肺腔内肿块增大及浸润性阴影。根据其临床和影像学特征以及血清学检查阳性，诊断为慢性坏死性曲霉病。尽管给予了伊曲康唑和两性霉素B，但空洞和腔内真菌球阴影持续增大。抗真菌药物与乌司他丁联合治疗显著改善了症状，胸部CT扫描显示真菌球完全消失。
