Endobronchial Aspergilloma with Hemoptysis in an Immunocompetent Patient: A Case Report and Literature Review

支氣管內麴菌球合併咳血於免疫健全患者：病例報告與文獻回顧

彭士軒(Shih-Hsuan Peng) ； 王勝輝(Sheng-Huei Wang) ； 彭忠衎(Chung-Kan Perng) ； 簡志峰(Chih-Feng Giian) ； 彭萬誠(Wann-Cherng Perng) ； 沈志浩(Chih-Hao Shen)

《胸腔醫學》 33卷2期 (2018/04) Pp. 76-83

摘要

Aspergillosis is associated with a variety of clinical infections in the thorax, and endobronchial aspergilloma is a rare presentation of pulmonary aspergillosis. Endobronchial aspergilloma may affect immunocompromised patients, but it is also found in immunocompetent patients. Herein, we describe the case of a 63-year-old woman without underlying disease who presented complaining of hemoptysis for 2 days. Chest computed tomography showed only an accumulation of fluid-like material at the bronchus of the right upper lobe. Persistent hemoptysis was apparent during the first 6 days of hospitalization. Flexible bronchoscopy revealed a ball-like mass of necrotic tissue that contained fungal hyphae as determined by histopathology, consistent with a diagnosis of endobronchial aspergilloma. The aspergilloma was removed and the patient's symptoms were relieved. This case highlights that endobronchial aspergilloma in immunocompetent patients may be associated with clinical pictures that differ from those of immunocompromised patients with endobronchial aspergilloma. Timely bronchoscopy to facilitate diagnosis is important for adequate management.

關鍵字

endobronchial aspergilloma ； hemoptysis ； immunocompetent

並列摘要

麴菌在胸腔內有許多不同的臨床形式，而支氣管內麴菌球則是少見的肺麴菌病表現。支氣管內麴菌球通常是影響免疫不全的病患，但也會在免疫健全的病患中發現。我們的案例報告是一位沒有潛在疾病的63歲女性，主訴咳血2天。胸部電腦斷層只發現有液體狀的物質堆積在右上葉支氣管內。但是咳血仍然在住院的前6天持續出現。支氣管鏡檢查則發現一顆包含壞死組織的球狀腫塊，這個腫塊的病理報告顯示內含真菌菌絲，因此診斷為支氣管內麴菌球。病患的症狀在此麴菌球被移除後也就逐漸緩減。這個病例說明免疫健全的病患感染支氣管內麴菌球時可能會和免疫不全的病患有不同的臨床表現。及時的支氣管鏡檢查對於診斷及適當的治療是很重要的。

並列關鍵字

支氣管內麴菌球 ； 咳血 ； 免疫健全