Treatment Experience with Itraconazole in Allergic Bronchopulmonary Aspergillosis: a Case Report

Allergic Bronchopulmonary Aspergillosis使用Itraconazole的治療經驗：一病例報告

洪敏德(Min-De Hung) ； 沈光漢(Gwan-Han Shen) ； 江自得(Chi-Der Chiang)

《胸腔醫學》 18卷4期 (2003/08) Pp. 356-361

https://doi.org/10.29806/TM.200308.0005

摘要

Allergic bronchopulmonary aspergillosis（ABPA）是一種對Aspergillus抗原產生過敏反應的疾病。典型地它伴發在慢性氣喘及囊性纖維化的病人身上。病人經常呈現喘鳴，塊狀棕色黏痰，發燒及肋膜性胸痛等症狀。根據Rosenberg在1977年提出的臨床診斷準則它包括：氣喘，血中嗜伊性紅血球增加，胸部X光浸潤，曲黴沈澱素（aspergillus precipitin），陽性曲黴抗原皮膚扎針試驗以及增加血中IgE濃度等。傳統上主要的治療是使用口服類固醇來壓抑免疫反應，讓急性惡化緩解或作維持治療。在此，我們提出一個使用Itraconazole治療後改善的例子。本例患者在治療後胸部X光明顯改善，並且血中總Ig-E濃度大幅下降。由於本例的經驗，我相信短期itraconazole的治療對ABPA可能具有明顯的效果。

並列摘要

Allergic bronchopulmonary aspergillosis (ABPA) is a disorder with a hypersensitivity reaction to Aspergillus antigens. Typically it is coexistent with long-standing asthma or cystic fibrosis. The patient usually presents with wheezing, expectoration of brown mucus plugs, fever, and pleuritic chest pain. According to Rosenberg et al in 1977, the diagnostic criteria include asthma, blood eosinophilia, chest radiographic infiltrates, Aspergillus precipitins, a positive skin prick test to Aspergillus antigens, and an increased serum Ig-E level. Traditionally, oral corticosteroids are the mainstay of treatment, either to suppress the immune response and thus alleviate acute exacerbation or to serve as maintenance therapy. Herein, we report a case which was treated successfully with itraconazole along with a low dose of prednisone. After treatment, there was significant resolution of the pulmonary infiltrates as well as a significant decrement in the serum IgE level. Because of this experience, we believe that short-term itraconazole treatment may have an impressive effect on APBA.

並列關鍵字

Allergic bronchopulmonary aspergillosis (ABPA) ； itraconazole