原發性球黴菌肺炎合併肋膜積水－臺灣一罕見病例報告

球黴菌性肺炎（Coccidioidal pneumonia）是因吸入球黴菌（Coccidioides immitis）而引起的肺部感染。此病主要為美洲地區之流行病；台灣至今尚未見有正式病例報告。三軍總醫院於76年7月間，經組織病理發現本病例。本文患者為32歲男性，因一週來冷顫、高燒、咳嗽及胸痛而入院診療。住院前八個月中，曾因經商及旅遊，分別赴美三次。理學檢查發現左肺呼吸音減弱，並有摩擦音。胸部X光顯示左下葉浸潤及肋膜積水。在經過盤尼西林靜注治療兩週無效後，遂行胸腔鏡檢及肋膜組織切片而得以證實。臨床症狀於Ketoconazole（400mg/day）治療兩週後改善。門診追踪至今六個月中，無復發徵象。因屬罕見，特提出報告，並回顧文獻以為日後納入鑑別診斷提供參考。

關鍵字

原發性球黴菌肺炎

並列摘要

Coccidioidomycosis is the mycosis acquired by inhalation of coccidioides immitis. It is most prevalent in the southwestern United States and Mexico. Symptomatic pulmonary infection is manifested by cough, fever, chest pain, malaise and sometimes hypersensitivity reactions. The chest roentgenogram is often abnormal. Diagnosis is readily achieved by demonstrating endosporulating spherules in sputum or inflammatory exudates. Amphotericin B, Ketoconazole and surgery are the major therapeutic modalities. We are here reporting a case of primary coccidioidal pneumonia presenting with pleural effusion. The patient was a 32-year-old male with a one-week history of chills, fever, cough and chest pain. The diagnosis involved detail travel history, clinical manifestations, thoracentesis and thoracoscopic pleural biopsy. The definite diagnosis was proven by histological evidence. The symptoms resolved with oral ketoconazole (400 mg/day) treatment. Because of rare literature reported in Taiwan, a discussion and review of literature were presented to provide clinical reference in the future.

並列關鍵字

Primary Coccidioidal Pneumonia ； Coccidioides immitis

國際替代計量

原發性球黴菌肺炎合併肋膜積水－臺灣一罕見病例報告

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