Pulmonary Cryptococcosis Mimicking Pulmonary Tuberculosis-A Case Report

在台灣，肺結核、隱球菌病(cryptococcosis)及卡氏肺囊蟲肺炎（在AIDS病患）是造成慢性肺炎的主要病原菌。若病人沒有痰或痰的抗酸性染色呈陰性的情況下，月市結核及肺隱球菌病的鑑別診斷將會很困難。傳統上，若接受嘗試性抗結核藥物治療後獲得臨床及影像學上的改善，則痰抹片陰性肺結核的診斷將更確定。但肺隱球菌病可能自愈，自愈也可能恰好發生在病人接受嘗試性抗結核藥物期間。因此，使用嘗試性抗結核藥物治療後有改善也不一定代表肺結核的診斷是正確的。我們報告一個肺隱球菌病病例，他因為在接受嘗試性抗結核藥物治療後有臨床及影像學上的改善而被誤診為痰抹片陰性肺結核。在下肺結核的診斷前，肺隱球菌病必須先被排除，否則將來會造成很大的困惑。我們倡議在開始使用嘗試性抗結核藥物治療前，先檢查血清中隱球菌抗原以降低將肺隱球菌病誤診為肺結核的機會。

關鍵字

肺隱球菌病；肺結核；隱球菌抗原；誤診；模仿

並列摘要

Pulmonary tuberculosis, cryptococcosis and Pneumocystis jirovecii pneumonia (in AIDS patients) are the principal causal agents of chronic lung infections in Taiwan. Differentiation between pulmonary tuberculosis and pulmonary cryptococcosis may be difficult if a sputum specimen either not available or tests negative for acid-fast staining. Traditionally, if clinical and radiographic improvements are achieved after an anti-tuberculosis ”therapeutic trial”, the diagnosis of sputum smear-negative pulmonary tuberculosis is strengthened. However, pulmonary cryptococcosis might also resolve spontaneously without anti-fungal therapy, and this improvement might occur during the trial period. Hence, response to an anti-tuberculosis therapeutic trial does not always confirm the diagnosis of pulmonary tuberculosis. We present a case of pulmonary cryptococcosis which was misdiagnosed as sputum smear-negative pulmonary tuberculosis. Pulmonary cryptococcosis must be excluded before the diagnosis of smear-negative pulmonary tuberculosis is made to prevent future confusion. We advocate checking the serum cryptococcal antigen before starting anti-tuberculosis treatment in smear-negative pulmonary tuberculosis, to minimize the possibility of misdiagnosis.

並列關鍵字

pulmonary cryptococcosis ； pulmonary tuberculosis ； cryptococcal antigen ； misdiagnosis ； mimic

國際替代計量

Pulmonary Cryptococcosis Mimicking Pulmonary Tuberculosis-A Case Report

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