Aspergillus Pericarditis Presenting As Anterior Mediastinal Malignancy

麴黴菌心包膜炎：臨床表現似前縱隔腔惡性腫瘤：病例報告

葉治浩(Chih-Hao Yeh) ； 高智泉(Chih-Chuan Kao) ； 金忠孝(Jong-Shiaw Jin)

《童綜合醫學雜誌》 11卷1期 (2017/06) Pp. 62-64

摘要

A 60-year-old woman had history of kidney transplantation 1 year ago and had received immunosuppressive drugs. She presented with fever, bilateral shoulder pain, lower abdominal pain, and poor appetite for 3 days. Wholebody positron emission tomography showed increase uptake in anterior mediastinum, pericardium, and lymph nodes, with the clinical impression of anterior mediastinal malignancy with lymph node and pericardium metastases. She received pericardiectomy and was diagnosed as having aspergillus pericarditis with abscess formation. Despite intensive antifungal treatment, she died of septic shock and multiple organ failure 3 weeks later. Aspergillus pericarditis occurs in immunocompromised patients and is always the result of contiguous dissemination of aspergillus from the lung or myocardium, with a high mortality rate. Only few cases have been successfully treated with intensive antifungal treatment and aggressive surgical pericardiectomy.

關鍵字

immunocompromised patients ； kidney transplantation ； septic shock ； pericardiectomy

並列摘要

一位60 歲女性一年前接受腎臟移植並接受免疫抑制性藥物治療，最近三天因發燒、雙側肩關節痛、下腹痛及食慾差求診。全身正子檢查顯示前縱隔腔、心包膜及淋巴結有異常顯影，因而懷疑前縱隔腔惡性腫瘤伴隨心包膜及淋巴結轉移。病患接受心包膜切除術後病理診斷為麴黴菌心包膜炎伴膿瘍。雖然積極用抗黴菌藥物治療，病患仍於術後三個星期死於敗血性休克及多重器官衰竭。麴黴菌心包膜炎好犯於免疫差的病患，通常是因為肺臟或心臟麴黴菌感染而擴散至心包膜，病患有很高的死亡率。只有少數病患接受積極抗黴菌藥物及心包膜切除術後可治癒。

並列關鍵字

免疫缺乏病人 ； 腎移植 ； 敗血性休克 ； 心包切除術