Pseudomembranous Tracheobronchitis Caused by Aspergillus in an Immunocompromised Patient-A Case Report

麵菌病會造成兔疫力失調病人產生偽膜性氣管支氣管炎－病例報告

張尚妙(Shang-Miao Chang) ； 林芳杰(Fung-J Lin) ； 曾歧元(Chi-Yuan Tzen) ； 許清寅(Chin-Yin Sheu) ； 郭許達(Hsu-Tah Kuo) ； 陳培然(Pei-Jan Chen)

《胸腔醫學》 19卷3期 (2004/06) Pp. 209-214

https://doi.org/10.29806/TM.200406.0006

摘要

侵略性的麵菌病(Invasive aspergillosis)是造成免疫力失調病人死亡的主要原因。我們提出一份報告有關患有麵菌病偽膜性氣管支氣管炎(Aspergillus Pseudomembranous tracheobronchitis)之免疫力失調病人的臨床病例，一位中年45歲患有糖尿病(Diabetic mellitus)的婦人，她初期呈現胸痛、咳嗽及呼吸困難的情況，我們將她視為酮酸症(Ketoaoidosis)及敗毒病作治療。之後她又產生氣道呼吸障礙的情形，在進行支氣管透視鏡檢查後顯示因粗糙組織造成偽膜性氣管支氣管炎(Pseudomembranous tracheobronchisis)有支氣管障礙的情形發生。偽膜性氣管支氣管炎(Pseudomembranous tracheobronchisis)是由有隔膜分支hypae的組織構成，此是與麵菌病(Aspergillosis)的種類相同的。即使進行人工換氣或抗菌治療，她還是死於因急速的呼吸障礙功能失調(Obstructive respiratory failure)。因此結論是當一個免疫力失調病人產生咳嗽、胸痛、發燒及呼吸困難的情況時，我們應該要立刻察覺麵菌病偽膜性氣管支氣管炎(Aspergillus pseudomebranous tracheobronchisis)的存在。早期的支氣管透視鏡檢查及組識檢驗，能早期接受治療延長存活率。

關鍵字

麵菌病(Aspergillosis) ； 偽膜性氣管支氣管炎(Pseudomembranous tracheobronchisis) ； 糖尿病(Diabetic mellitus) ； 酮酸症(Ketoacidosis) ； 呼吸障礙功能失調(Obstructive respiratory failure)

並列摘要

Invasive aspergillosis is a leading cause of death in immunocompromised patients. We herein report a case of pseudomembranous tracheobronchitis caused by Aspergillus in an immunocompromised patient. A 45-year-old woman with diabetes mellitus presented with chest pain and cough. She was found to be in diabetic ketoacidosis and was treated for that and possible respiratory sepsis. She subsequently developed airway obstruction and respiratory failure. Bronchoscopic examination revealed pseudomembranous tracheobronchitis with granulation tissue obstructing several bronchi. The pseudomembrane consisted histologically of septate hyphae branching at 45°, consistent with Aspergillus species. Despite mechanical ventilation and antifungal therapy, the patient succumbed to progressive obstructive respiratory failure. Aspergillus tracheobronchitis should be considered in immunocompromised patients presenting with cough, chest pain, fever, dyspnea and upper airway obstruction. Early bronchoscopy and histologic examination should be performed and all clinical isolate of Aspergillus spp should be identified to species level because early definitive treatment may be life-saving.

並列關鍵字

diabetes mellitus ； aspergillus ； pseudomembranous tracheobronchitis ； ketoacidosis ； obstructive respiratory failure