喉部隱球菌感染－病例報告

喉部隱球菌感染相當罕見，病患多爲自體免疫不全、長期使用免疫抑制劑或類固醇之患者；此類病患亦常有居住環境鄰近養鴿場所，或是長期接觸家禽之情況。本院經歷1名60歲男性，主訴聲音沙啞約3個月，相關症狀伴隨些許咳嗽，但無喉嚨痛、體重減輕、呼吸困難等症狀，病患亦無發燒現象。病患生活習慣上無抽菸、飲酒及嚼食檳榔，亦無接觸鴿類或家禽等相關病史。過去病史有高血壓，糖尿病及痛風，均在追蹤及藥物控制中。喉部纖維内視鏡檢查發現右側聲帶紅腫且合併肉芽性病灶。病人住院接受喉直達鏡顯微手術，進行病灶切片（punch biopsy）。相關病理切片染色呈現出隱球菌感染之特徵，病理診斷爲慢性發炎性肉芽腫合併隱球菌感染。其人類免疫缺陷病毒及梅毒之血清抗體篩檢，均呈陰性反應；痰液培養並未發現隱球菌或結核菌的生長；血清隱球菌抗原（cryptococcus antigen）亦呈陰性反應。由於病患並無免疫不全之相關疾病，且未有系統性感染，因此並未給予藥物治療，建議病患持續於門診追蹤。術後第5年之纖維内視鏡檢查，顯示無喉部隱球菌感染復發之情形。因屬罕見病例，特提出報告。

關鍵字

larynx ； cryptococcus ； immunocompetent（喉部；隱球菌；免疫健全）

並列摘要

Cryptococcus infection in the larynx is a rare disease. It causes infection mostly in the immunocompromised hosts, such as AIDS patients, long-term users of immunosuppressant or steroid, or those living near a pigeon farm or exposed to poultry. One 60-year-old man complained of hoarseness for 3 months. There were no associated symptoms except mild cough. He did not have a habit of cigarette smoking, alcohol drinking or betel quid chewing. There were neither pigeon farm nor poultry holdings in his neighborhood. In the laryngeal fiberscope examination, there was a granular lesion with erythematous swelling appearance on the right vocal cord. He underwent punch biopsy via laryngomicrosurgery. Pathologic study revealed granulomatous inflammation with fungal infection suggesting cryptococcosis. The serum anti-HIV antibody, nontreponemal test for syphilis, and cryptococcus antigen were all negative. Sputum culture did not reveal cryptococcus or mycobacterium growth. Since the patient was not immunocompromised and had no sign of systemic infection, we recommended regular outpatient follow-up. There had been no sign of systemic dissemination or recurrence in the fiberscope study during the five years after the operation.

並列關鍵字

larynx ； cryptococcus ； immunocompetent

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喉部隱球菌感染－病例報告

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