以变应性支气管肺曲霉菌病为共病求诊的嗜酸性肉芽肿性多血管炎一例及文献复习  

Eosinophilic granulomatous polyangiitis with allergic bronchopulmonary aspergillosis as a comorbidity:a case report and literature review

作　　者：楚燕芳 李亚卓 徐鹏慧 孔祥艳 叶彬 卢敏辉 周惠琼 Chu Yanfang;Li Yazhuo;Xu Penghui;Kong Xiangyan;Ye Bin;Lu Minhui;Zhou Huiqiong(Department of Rheumatology and Immunology,the Fourth Medical Center,Chinese PLA General Hospital,Beijing 100048,China;Department of Pathology,the Fourth Medical Center,Chinese PLA General Hospital,Beijing 100048,China)

机构地区：[1]中国人民解放军总医院第四医学中心风湿免疫科,北京100048 [2]中国人民解放军总医院第四医学中心病理科,北京100048

出　　处：《中华风湿病学杂志》2021年第12期811-815,I0002,共6页Chinese Journal of Rheumatology

摘　　要：目的探讨以变应性支气管肺曲霉菌病(ABPA)为共病的嗜酸性肉芽肿性多血管炎(EGPA)的临床特点及诊疗方法。方法收集1例以ABPA为共病求诊的EGPA患者的临床病历资料,总结患者的诊疗过程,并进行文献复习,探讨ABPA及EGPA发病机制的相关性和诊疗经验。结果该病例为老年男性,反复咳嗽、咳痰、咯血、喘憋,化验嗜酸性粒细胞、IgE升高,烟曲霉菌试验阳性,胸部CT示肺部结节影、支气管扩张,诊断为ABPA。患者出现肢体麻木、鼻窦炎、肾功能异常诊断为EGPA。给予糖皮质激素、免疫抑制剂及抗真菌等治疗后病情好转。复习相关文献,共检索到10篇个案报道,共报道10例患者,其中5例先诊断为ABPA,后诊断为EGPA;3例先诊断为EGPA,后诊断为ABPA;2例同时诊断。二者在发病机制上有一定的相关性,治疗上以糖皮质激素、免疫抑制剂及抗真菌药物为主。结论以ABPA为共病的EGPA病例鲜有报道,提醒在临床工作中当诊断其中一种疾病时要警惕是否有另一种疾病共存,避免漏诊或误诊。Objective To explore the clinical characteristics,diagnosis and treatment of allergic bronchopulmonary aspergillosis(ABPA)with eosinophilic granulomatous with polyvasculitis(EGPA)as a comorbidity.Methods We collected the clinical data of a patient with EGPA who sought treatment with ABPA as a comorbidity.We summarized the diagnosis and treatment process of the patient,and reviewed the literature.After that,we discussed the relationship between the pathogenesis of ABPA and EGPA and the diagnosis and treatment experience.Results A 61-year-old male patient suffered from repeated coughing,expectoration,hemoptysis,wheezing.His blood eosinophils count and immunoglobulin(Ig)E level were elevated.He was tested positive for aspergillus fumigatus.His Computer Tomography(CT)showed pulmonary nodules and bronchiectasis.He was diagnosed as ABPA.He also suffered limb numbness,sinusitis,and renal dysfunction and was diagnosed as EGPA.His condition improved after treatment with glucocorticoids,immunosuppressants and antifungal agents.We reviewed the relevant literature and retrieved 10 case reports,of which 5 cases were diagnosed as ABPA first and then EGPA,3 cases were diagnosed as EGPA first and then ABPA,2 cases were diagnosed simultaneously.We found that there was a certain correlation between them in the pathogenesis,and the main treatment is glucocorticoids,immunosuppressants and antifungal drugs.Conclusion ABPA with EGPA as a comorbidity is rarely reported,which reminds us that when diagnosing one of the diseases in clinical work,we should be alert to the coexistence of another disease to avoid misdiagnosis.

关 键 词：曲霉菌病 变应性支气管肺 血管炎 嗜酸性粒细胞 哮喘 

分 类 号：R519[医药卫生—内科学] R593.2[医药卫生—临床医学]