原发性肺隐球菌病1例并文献复习  

Primary pulmonary cryptococcosis:a case report and review of the literature

作　　者：洪如钧[1] 谢宝松[1] 李瑞慧[1] 岳文香[1] 郑冠英[1] 

机构地区：[1]福建省立医院呼吸内科,福州350001

出　　处：《创伤与急诊电子杂志》2014年第4期47-50,共4页Journal of Trauma and Emergency(Electronic Version)

摘　　要：目的提高临床医师对原发性肺隐球菌病(pulmonary cryptococcosis,PC)的认识。方法对1例确诊为原发性肺隐球菌病患者的临床资料进行分析,并结合文献复习。结果患者男性,29岁,以"咳嗽、咳痰1月,气促22天"为主诉于2014年7月12日收住福建省立医院呼吸内科。于外院查胸部CT示双肺胸膜下多发结节、团片影伴空洞形成,经支气管镜活检病理检查提示肺隐球菌病,经氟康唑抗真菌治疗效果欠佳。入院后再行经皮肺穿刺病理及组织培养均证实肺隐球菌病,评估病情考虑重症PC,予两性霉素B脂质体联合5-氟胞嘧啶诱导治疗1月后改用氟康唑巩固治疗,临床症状缓解,复查肺部病灶明显吸收。结论原发性肺隐球菌病缺乏特异性的临床和影像学表现,容易误诊、误治。确诊主要依靠病理和病原学检查,经皮肺穿刺活检是值得推荐的获取组织标本的手段。重症肺隐球菌病患者少见,获得组织病理诊断的同时应积极争取行组织培养及药敏试验,治疗方案应参照中枢神经系统感染。Objective To improve the awareness of primary pulmonary cryptococcosis(PC).Method One case of primary pulmonary cryptococcosis was analysed and relevant literatures were reviewed. Result A 29-year-old male patient was admitted to the hospital on July, 2014 because of cough and expectoration for a month and dyspnea for 22 days.The lung CT showed multiple subpleural patchy or mass shadows within the both lungs. The bronchial lung biopsy has confirmed the dianogsis.Fluconnazole was given intravenously for 2 weeks but failed. A percutaneous lung biopsy and a pathological examination were performed to comfirm the diagnosis of PC again.The patient was reevaluated and considered as severe condition.Amphotericin B plus 5-fluorine cytosine were used for 1 month and followed by fluconazole as the antifungal therapy.The patient's condition was alleviated and the lung lesion was significantly absorbed.Conclusion Primary pulmonary cryptococcosis lacking in specificities of clinical and imaging findings is easily misdiagnosed and mistreated.Prompt lung biopsy and pathology with special stains can confirm the diagnosis. Less invasive percutaneous lung biopsy is recommended. As severe condition was less commonly seen in PC patients, clinicians should strive to obtain tissue cultures and perform a sensitivity test.Antifungal therapy should refer to the cryptococcus neoformans meningitis treatment.

关 键 词：非免疫缺陷 原发性肺隐球菌病 诊断 治疗 

分 类 号：R519[医药卫生—内科学]