產後隱球菌肺炎－病例報告

Postpartum Cryptococcal Pneumonia: A Case Report

陳寬榮(Kuan-Jung Chen) ； 王喬弘(Chiao-Hung Wang) ； 詹雲翔(Yun-Hsiang Chan)

《北市醫學雜誌》 12卷2期 (2015/06) Pp. 86-90

https://doi.org/10.6200/TCMJ.2015.12.2.10

摘要

目的：隱球菌感染是一個重要的伺機性感染，臨床上以中樞神經系統為好發位置，其次則是肺部感染。通常此症易發生於免疫力低下之病人如HIV感染者，不過免疫力正常的人罹患肺部隱球菌感染亦非罕見。至於在懷孕期間與產後感染隱球菌肺炎，且病人非免疫力低下患者之案例則極少見。病例報告：一位42歲女性，於產後二週入住產後護理之家時，於入住前例行性胸部X光檢查發現右下肺實變，進一步檢查發現血清隱球菌抗原陽性，且肺部切片檢查證實為肺部隱球菌感染。經投與Fluconazole治療半年後，胸部x光有大幅改善。結論：懷孕期間是屬於生理上免疫較為低下的狀況，所以發生肺炎時應將隱球菌感染列為鑑別診斷之一。

關鍵字

隱球菌肺炎 ； 懷孕 ； 產後

並列摘要

Cryptococcus is an opportunistic pathogen with great affinity to immune-compromised hosts, usually among the HIV-infected subjects. The primary tropism is the central nervous system, followed by the lungs. Though, development of cryptococcal pneumonia in immune-competent hosts is not uncommon. Cryptococcal pneumonia in immunocompetent pregnant women and in the postpartum period has been rarely reported. We report a case of cryptococcal pneumonia infection in a 42-yearold woman who was 2 weeks postpartum at the time of her arrival at the hospital. The patient presented with mild cough with scanty sputum and sensation of shortness of breath. The chest X-ray showed right lower lobe consolidation. Both surgical pathology examination and serum cryptococcal Ag examination confirmed the diagnosis of cryptococcal pneumonia, and fluconazole therapy was initiated. Chest X-ray taken 6 months later shows that the lesion was almost totally resolved. Because pregnancy is associated with physiological immune-suppression, cryptococcal pneumonia should be considered in pregnant women, or women in the post-partum period who have respiratory symptoms.

並列關鍵字

cryptococcal pneumonia ； pregnancy ； postpartum