Successful Treatment with Itraconazole for Chronic Necrotizing Pulmonary Aspergillosis with a Delayed Diagnosis-A Case Report

經Itraconazole成功治療的慢性壞死性肺麹菌病－病例報告

陳嘉明(Ka-Ming Chan) ； 吳沼漧(Chao-Chien Wu) ； 林孟志(Meng-Chih Lin) ； 黃昭誠(Chao-Cheng Huang)

《胸腔醫學》 20卷1期 (2005/02) Pp. 51-57

https://doi.org/10.29806/TM.200502.0007

摘要

在此我們報告一位65歲患有糖尿病的女性病患，住院之前以呼吸困難伴隨呼吸急迫來表現，急診發現有高血糖症的現象，並有糖尿病性酮酸血症伴隨代謝性酸中毒。住院期間，在疑似續發性肺部感染之下，因呼吸衰竭而接受插管及呼吸器治療。臨床上的改善無法和一系胸部X-光相吻合，胸部X-光發現有進行性的肺部浸潤以及之後的空洞形成。肺麴菌病經由氣管組織切片證實。根據病患臨床上的亞急性表現，近似慢性壞死性肺麴菌病。但延遲診斷已發生，可足以引起高罹病率和死亡率。經過近6個月itraconazole的抗黴菌治療，肺部恢復幾近完全正常。

關鍵字

慢性壞死性肺麴菌病 ； 半侵入性肺麴菌病 ； 肺麴菌病

並列摘要

A 65-year-old diabetic female patient presented with dyspnea and respiratory distress before admission. Hyperglycemia was evident on admission, and diabetic ketoacidosis (DKA) was confirmed. She was intubated with ventilator support due to respiratory failure. The clinical course improved despite progressive pulmonary infiltration and cavitation after extubation. Pulmonary aspergillosis was confirmed by bronchial biopsy. Chronic necrotizing pulmonary aspergillosis (CNPA) was highly likely, based on the patient's subacute course. But the diagnosis was delayed, which could have led to more morbidity and a greater chance of mortality. Despite a two-month delay in diagnosis for this patient, her lung lesion completely regressed after a nearly 6-month outpatient antifungal therapy regimen with itraconazole.

並列關鍵字

chronic necrotizing pulmonary aspergillosis ； semi-invasive pulmonary aspergillosis ； pulmonary aspergillosis