- 期刊
Allergic Bronchopulmonary Aspergillosis: A Case Report
過敏性肺支氣管麴菌症
摘要
麴菌在肺部所引起的病變有麴菌瘤，侵犯性麴菌病變及過敏性肺支氣管麴症等三種。過敏性肺支氣管麴菌症主要是對於寄生在支氣管內的麴菌所產生過敏反應的一種病症。此病症在西方界為常見，然而在台灣則罕見，過敏性肺支氣管麴菌症的主要診斷依據為(1)支氣管性氣喘，(2)肺部有瀰漫性病變，(3)嗜伊性白血球增加，(4)對於薰煙色麴菌的皮膚試驗為陽性，(5)對於薰煙色麴菌的血清抗體為陽性，(6)血中免疫球蛋白Ｅ上昇，(7)中央型支氣管擴張。我們報告一位過敏性肺支氣管麴菌症病人，此病人有5年像氣喘的咳嗽，在發病前，他曾在遠洋漁船的秣草儲藏室裡工作兩年，在此5年之中，他曾做過四次住院檢查，接受5次求氣管鏡查及一次開胸肺部切片，仍然無法確定診斷，最後，這位病人來到我們醫院住院，痰液中明顯的嗜伊性白血球增多引導我們從嗜伊性肺疾病之鑑別診斷去著手，雖然痰液中的薰煙色麴菌培養為陰性，血清薰煙色麴菌抗體為陰性，所幸，支氣管攝影顯現中央型支氣管擴張我我們碇定診斷為過敏性肺支氣管麴菌症。
關鍵字
無資料並列摘要
Aspergillus-associated pulmonary disease are aspergilloma, invasive aspergillosis, and allergic bronchopulmonary aspergillosis. Allergic bronchopulmonary aspergillosis is caused by a complex of immunologic reactions to the presence of the Aspergillus species colonizing the bronchial trees. The disease is not common in Taiwan. The major diagnostic criteria for allergic bronchopulmonary aspergillosis are 1) bronchial asthma, 2) pulmonary infiltration, 3) peripheral eosinophilia, 4) positive skin test to Aspergillus fumigatus, 5) serum precipitin to Aspergillus fumigatus, 6) elevated serum Ig E, and 7)central bronchiectasis. We report a case who has had a chronic asthmatic-like cough for 5 years. He worked in a silo for two years before he was troubled by the disease. He was admitted to hospitals four times in the past, and received five bronchoscopeic examinations and one open lung biopsy without definite diagnosis. Sputum eosinophilia directed our attention to the differentiation of eosinophilic lung diseases A bronchogram which revealed central brochiectasis helped us to make the diagnosis of allergic bronchopulmonary aspergillosis, despite negative sputum culture for Aspergillus fumigatus and negative serum precipitin to Aspergillus fumigatus.