- 期刊
Pulmonary Alveolar Proteinosis Complicated with Cryptococcal Pneumonia-A Case Report
肺泡蛋白質沉積症合併隱球菌肺炎－病例報告
摘要
肺泡蛋白質沉積症是廣泛性的肺部疾病，特徵為在末端肺泡有呈現PAS染色陽型的脂蛋白物質沉積。肺部僅有輕微的發炎或無發炎現象而肺部本身的結構沒有受到破壞。肺泡蛋白質沉積症常併發一些平常少見的感染，特別是奴卡氏菌。但肺泡蛋白質沉積症合併隱球菌感染則較少有報告。我們報告一個罕見的肺泡蛋白質沉積症合併隱球菌感染病例。患者胸部先表現出X光上雙側肺野的陰影，並有數個月的間歇性的發燒及乾咳症狀。經過針對一般肺炎的標準治療之後無明顯的改善。胸部電腦斷層顯示出兩側肺野多處的毛玻璃狀病灶，肺小葉中隔增厚及碎石路狀徵候（crazy paving appearance）。病理切片顯示為肺泡蛋白質沉積症合併隱球菌感染。在給予15個月的Fluconazole治療後，患者隱球菌血清抗原指數由1024X下降至128X。
並列摘要
Pulmonary alveolar proteinosis (PAP) is a diffuse lung disease characterized by the accumulation of periodic acid-schiff (PAS)-positive lipoproteinaceous material in the distal air spaces. There is little or no lung inflammation, and the underlying lung architecture is preserved. PAP is occasionally complicated with infections caused by unusual organisms, such as Nocardia, though cryptococcosis has seldom been reported. We reported a patient with PAP superimposed with cryptococcal pneumonia that initially presented with bilateral lung opacities, intermittent fever and dry cough for several months. The patient failed to respond to standard treatment for community acquired pneumonia. Chest computed tomography (CT) revealed multifocal patchy ground-glass opacities and interlobular septal thickening, with a crazy-paving appearance scattered in both lungs. The video-assisted thoracic surgery (VATS) pathology report suggested PAP with cryptococcal pneumonia. Fluconazole was given and the cryptococcal antigen decreased from 1024X to 128X after 15 months of treatment.
延伸閱讀
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