Nakagawa Y, Shimazu K, Ebihara M, Amann K
Department of Internal Medicine, National Kumamoto South Hospital, Japan.
Nihon Kokyuki Gakkai Zasshi. 1998 Mar;36(3):294-8.
A 65-year-old man was admitted to our division with of productive cough and hemosputum. Chest radiographs and chest CT on admission showed old inflammatory shadows in both upper lung fields and a fungus ball in the left upper lung field. Despite antibiotic treatment, the patient's sputum volume increased and Aspergillus niger was repeatedly cultured from his sputum. Chest radiographs showed deterioration around the intracavitary fungus ball and a test for serum aspergillus antigen was positive. Secondary invasive pulmonary aspergillosis originating from aspergilloma was diagnosed based on his clinical symptoms, radiographic features and laboratory data. Administration of fluconazole failed to improve his clinical course and amphotericin B was discontinued because of hypokalemia. Oral administration of itraconazole was a successful treatment.
一名65岁男性因咳痰和咯血入住我科。入院时胸部X线片和胸部CT显示双上肺野有陈旧性炎症阴影，左上肺野有一个真菌球。尽管进行了抗生素治疗，但患者痰量增加，痰中反复培养出黑曲霉。胸部X线片显示腔内真菌球周围病情恶化，血清曲霉抗原检测呈阳性。根据患者的临床症状、影像学特征和实验室数据，诊断为由曲菌球引起的继发性侵袭性肺曲霉病。氟康唑治疗未能改善其临床病程，两性霉素B因低钾血症而停用。口服伊曲康唑治疗成功。
