Pulmonary Coccidioidomycosis Manifesting as a Single Pulmonary Nodule-A Case Report and Literature Review

球孢子菌病以單一肺結節表現－病例報告及文獻回顧

趙文震(Wen-Cheng Chao) ； 詹明澄(Ming-Cheng Chan) ； 詹以吉(Yee-Jee Jan) ； 許正園(Jeng-Yuan Hsu)

《胸腔醫學》 21卷3期 (2006/06) Pp. 298-304

https://doi.org/10.29806/TM.200606.0012

摘要

球孢子菌病(Coccidioidomycosis)是美國西南方沙漠區域常見黴菌感染，可對免疫力正常或不正常的人造成感染，早期臨床症狀通常很輕微，常見為咳嗽和發燒並無特異性表徵，大多數感染不需藥物治療，但少數病人會有全身性的感染，早期診斷及治療對此部分病人相當重要，另外5%至10%病人感染過後肺部會遺留下一些結節或空洞。我們在此報告一個免疫力正常患者，該病人兩年前曾於美國亞利桑那工作，當時曾因胸痛於該地住院，影像學檢查發現左肺有結節性病灶且經血清學檢查證實為球孢子菌感染，病人症狀經口服抗黴菌藥物治療後改善，此次病患因胸痛復發且影像學檢查仍然發現左肺有一結節性病灶，經手術切除後證實該結節為球孢子菌感染。我們並且回顧文獻，探討球孢子菌病的生活史、臨床表現、診斷及處置。

關鍵字

球孢子菌病coccidioidomycosis ； 肺結節pulmonary nodule

並列摘要

A previously healthy 40-year-old man with pulmonary coccidioidomycosis presented with a solitary pulmonary nodule. The diagnosis was made by wedge resection with histological proof and a previously positive serology test for coccidioidomycosis IgG. The patient had suffered from left chest pain in 2003 when he worked in Arizona. A left lung nodular lesion was found by chest film, and pulmonary coccidioidomycosis was diagnosed at that time, on the basis of positive serum coccidioidomycosis IgG. He underwent anti-fungal treatment there for about 3 months, and the chest pain subsided. In May 2005, he visited our chest medicine outpatient department because of a recurrence of chest pain. The chest X-ray disclosed a 2.5 cm nodule in the left lung. A wedge resection was performed and histopathology of the lesion demonstrated caesous granulomatous inflammation with some Langerhan's giant cells. The Gomori methenamine silver (GMS) and periodic acid-Schiff (PAS) stains disclosed several spherules containing some small endospores. The histopathological picture was compatible with Coccidioides infection. Literature concerning the life cycle, manifestation, diagnosis, treatment, and pulmonary sequelae of coccidioidomycosis is also reviewed.

並列關鍵字

coccidioidomycosis ； single pulmonary nodule