以咯血为突出表现的COPD并侵袭性肺曲霉病误诊一例  

A Misdiagnosed Case of Chronic Obstructive Pulmonary Disease Combined with Invasive Pulmonary Aspergillosis as Hemoptysis of Prominent Manifestation

作　　者：黄慧[1] 张健[1] 杨庭义 吴冰[1] 

机构地区：[1]兰州军区兰州总医院保健一部,兰州730050

出　　处：《临床误诊误治》2013年第11期29-32,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的分析慢性阻塞性肺疾病(COPD)并侵袭性肺曲霉病(IPA)的临床特征及误诊原因,以期提高早期诊治水平。方法对以咯血为突出表现的COPD并IPA误诊1例的临床资料进行回顾性分析。结果本例以咯血为突出表现,经相关医技检查拟诊为肺部感染、支气管扩张症,予广谱抗生素、糖皮质激素治疗无效且病情加重,3次痰培养提示曲霉菌感染,真菌葡聚糖及内毒素检查阴性,行抗真菌治疗后,临床治愈。确诊为COPD并IPA。结论 COPD并IPA临床诊断较困难,综合分析患者临床表现及多次行影像学、微生物学、血清学检查是提高该病诊断率、改善患者预后的有效手段。Objective To analyze clinical manifestations and misdiagnosed causes of chronic obstructive pulmonary disease （COPD） combined with invasive pulmonary aspergillosis （IPA） in order to improve the early diagnosed level.Methods Clinical data of a misdiagnosed case of COPD combined with IPA as hemoptysis of prominent manifestation was retrospectively analyzed.Results The patient with hemoptysis as prominent manifestation was misdiagnosed as having pulmonary infection and bronchiectasis after relevant medical examinations,and therapy of broad spectrum antibiotics and glucocorticoid failed with worsening pathogenetic condition.Results of sputum culture for 3 times showed aspergillus infection,and negative fungal glucan and endotoxin,and in the end the patient was clinically cured by antifungal treatment.The COPD combined with IPA was confirmed.Conclusion It is difficult to correctly diagnose COPD combined with IPA,and clinicians can improve the diagnosis level and prognosis by comprehensively analyzing clinical features,and undertaking radiological examinations,microbiological examinations and serological tests repeatedly.

关 键 词：肺疾病 慢性阻塞性 咯血 肺曲霉病 侵袭性 误诊 支气管扩张症 

分 类 号：R519[医药卫生—内科学]