Chronic Necrotizing Pulmonary Aspergillosis: A Case Report

慢性壞死性肺麴菌病：病例報告

洪保龍(Paw-Loong Ang) ； 夏德椿(Te-Chun Hsia) ； 杭良文(Liang-Wen Hang) ； 林智一(Tze-Yi Lin) ； 楊蓴(Shwen Yang)

《胸腔醫學》 17卷3期 (2002/09) Pp. 290-296

摘要

慢性壞死性肺麴菌病又稱為半侵入性肺麴菌症，是一由麴菌屬所造成的罕見肺部感染且通常發生於免疫缺乏患者身上。在此我們報告一位38歲男性患者，以呼吸困難，發燒，貧血及血小板缺乏症表現來院。經骨髓檢查證實為急性白血病之後，他開始接受化學治療。化學治療後發生嗜中性顆粒細胞減少性發燒，因此他接受廣效性抗生素治療。但由於持續的嗜中性顆粒細胞減少性發燒，因此加上抗黴菌藥物。此時病患胸部X光片顯示雙側多發性結節病兆。氣管鏡檢查並未得到確診，因此建議病患接受進一步胸廓切開術檢查。後來病理報告證實為慢性壞死性肺麴菌病。診斷慢性壞死性肺麴菌病，須靠臨床上的高度警覺性，並且須小心的排除肺結核及其他厭氧性感染等。治療上以抗黴菌藥物為主，若是內科療法失敗則可考慮外科手術治療。

關鍵字

慢性壞死性肺麴菌病 ； 半侵入性肺麴菌症 ； 麴菌病

並列摘要

Chronic necrotizing pulmonary aspergillosis (CNPA), also known as semi-invasive pulmonary aspergillosis, is a rare pulmonary infection caused by the genus Aspergillus, and usually is found in immunosuppressed patients. We report a 38-year-old man presenting with dyspnea, fever, anemia, and thrombocytopenia prior to admission. Acute myeloid leukemia (AML), M1, was diagnosed at the base of his bone marrow study. During the course of hospitalization, he developed neutropenic fever after induction chemotherapy. Initially, he was treated with a regimen of broad spectrum antibiotics, and then an anti-fungal agent was added for the prolonged neutropenic fever. Chest radiography showed multiple cavitary nodular lesions in both lungs. The transbronchial biopsy could not yield a diagnosis. Therefore, the patient underwent an exploratory thoracotomy, and the pathology confirmed a diagnosis of semi-invasive pulmonary aspergillosis. In order to reach a diagnosis of chronic necrotizing pulmonary aspergillosis, a high degree of clinical suspicion is required. Pulmonary tuberculosis and anaerobic infections should be carefully excluded. Treatment is based on the administration of anti-fungal drugs. In the event of a failure of medical treatment, thoracic surgery may be indicated.

並列關鍵字

chronic necrotizing pulmonary aspergillosis ； semi-invasive pulmonary aspergillosis ； aspergillosis