Endobronchial Actinomycosis Associated with a Foreign Body and Presenting as Asthma

異物吸入併發支氣管內放線菌感染以氣喘為臨床表現：病例報告

陳正雄(Cheng-Hsiung Chen) ； 林慶雄(Ching-Hsiung Lin) ； 溫仁和(Jen-Ho Wen) ； 林楷煌(Kai-Huang Lin) ； 王竹賢(Chu-Hsien Wang) ； 孫健聰(Kian-Choon Soon) ； 何明霖(Ming-Lin Ho) ； 李建德(Chien-Te Li)

《胸腔醫學》 19卷4期 (2004/08) Pp. 250-254

https://doi.org/10.29806/TM.200408.0003

摘要

放線菌病很少是造成支氣管內腫塊之原因，且與吸入異物有關之病例僅有少數被提出，此次報告個案為一位57歲女性，主要臨床表現為持續四年有無法控制之喘嗚呼吸聲，當時被診斷為氣喘，雖口服類固醇、茶鹼(Theophylline)及乙二型交感神經興奮劑(β2-agonist)仍無法有效控制其氣喘症狀。從理學檢查中發現兩側喘嗚呼吸聲且右下肺野喘嗚聲強度增加，而胸部X光檢查無異常發現。因這一無法有效控制之喘嗚呼吸聲，所以安排支氣管鏡檢查以排除支氣管內之病變，支氣管鏡檢查發現在右邊中間支氣管 ( Intermediate bronchus)有一黃色硬的腫塊，約阻塞70％之管腔且周圍之黏膜呈現紅腫情形，病理組織報告顯示絲狀之細菌體形成磺腰顆粒(Sulfur granules)此符合放線菌病之診斷。此個案治療是採每6小時靜脈注射3百萬單位青黴素(Penicillin), 2星期後仍每6小時給予口服青徽素(Amoxil) 250毫克並持續治療一年，之後支氣管鏡的追蹤檢查結果顯示支氣管黏膜發炎反應已有改善，但支氣管內之腫塊僅部分縮小；因此予施行胸廓切開術(Thoracostomy)和支氣管部分切除術(Bronchotomy) ，共切除了四塊類似動物骨頭之組織，個案於術後氣喘症狀完全緩解且不需支氣管擴張劑的治療。
就這個病例而言，吸入異物而引發放線菌感染，其所導致呼吸道慢性發炎反應是造成無法控制之支氣管痙攣之原因。一般氣管內放射菌病可成功的單獨使用抗生素治療。然而，若是治療效果不佳時，是否合併異物吸入是需被審慎考慮的。

關鍵字

放線菌病(Actinomycosis) ； 支氣管鏡(Fiberoptic bronchoscopy) ； 氣喘(Asthma) ； 異物(Foreign body)

並列摘要

Actinomycosis as the cause of an endobronchial mass is rare, and its association with a foreign body has only been described in a few reports. We herein report a 57-year-old female who was diagnosed as having asthma with intractable wheezing for about four years. Her symptoms were poorly controlled by oral prednisolone, theophylline and β2-agonist. Physical examination revealed bilateral wheezing on chest auscultation with an increased wheeze intensity in the right lower lung field. Chest radiography was normal. Because of the uneven wheeze, bronchoscopy was arranged to rule out an endobronchial lesion. A yellowish hard mass was noted in the right intermediate bronchus obstructing about 70 % of the lumen. The surrounding mucosa was hyperemic and edematous. Histologic examination showed colonies of filamentous bacteria forming sulfur granules consistent with actinomycosis. The patient was treated with intravenous penicillin, 3-million units every 6 hours for two weeks, followed by oral amoxicillin 250 mg every 6 hours for one year. Repeated bronchoscopy showed improvement in the mucosal inflammation, but the endobronchial tumor had only partially regressed. A thoracotomy with bronchotomy was performed, and four pieces of a foreign body (animal bone tissue) were removed. After operation, her asthma symptoms resolved without the use of a bronchodilator.
Aspiration of a foreign body with chronic inflammation of the airways due to actinomycosis may have contributed to the intractable bronchospasm in this case. Since actinomycosis can be treated successfully with antibiotics alone, actinomycosis associated with an endobronchial lesion should be suspected in patients who respond poorly to antibiotic treatment.

並列關鍵字

actinomycosis ； fiberoptic bronchoscopy ； asthma ； foreign body