1例肺隐球菌病误诊为肺结核病例的临床诊疗分析  

Analysis of Clinical Diagnosis and Treatment of One Case with Pulmonary Cryptococcosis Misdiagnosed as Pulmonary Tuberculosis

作　　者：范欣欣 吴迪 林友飞 陈晓红 刘加夫 FAN Xin-xin;WU Di;LIN You-fei;CHEN Xiao-hong;LIU Jia-fu(Department of Tuberculosis,Fuzhou Pulmonary Hospital,Fuzhou 350008,China;Department of Pathology,Fuzhou Pulmonary Hospital,Fuzhou 350008,China)

机构地区：[1]福州肺科医院结核科,福州350008 [2]福州肺科医院病理科,福州350008

出　　处：《抗感染药学》2023年第10期1103-1107,共5页Anti-infection Pharmacy

基　　金：福建省省级临床重点专科建设项目(结核病科)/福州市“十四五”临床专科培强培优培育建设项目(编号:20230104)。

摘　　要：目的:探究1例肺隐球菌病误诊为肺结核病例的临床诊疗特点,并进行文献复习,为提高对肺隐球菌病的认识提供参考。方法:患者因体检发现肺部阴影而入院治疗,外院胸部CT检查示“右肺上叶多发斑片状影,边缘模糊,右肺下叶前基底段见少许斑片状、斑点状模糊影”,因而临床诊断为继发性肺结核。结果:入院后完善检查,纤支镜检查未见明显异常,结核菌素纯蛋白衍生物(purified protein derivative,PPD)试验阴性,于是排除肺结核诊断;行支气管镜肺活检术(transbronchial lung biopsy,TBLB)取肺组织进行特殊染色,结果六胺银染色阳性、黏液卡红染色阳性,并且可见少许真菌荚膜,符合隐球菌感染的相关特点,遂予氟康唑治疗,患者症状也最终好转。结论:肺部结节样病变要注意发病部位与易忽视的晕征,其多见于肺真菌病早期;肺隐球菌病的临床症状与影像学表现无特征性,当肺部病灶形态以结节为主要表现,且又位于上叶尖后段和下叶背段时易被误诊为肺结核,确诊需依靠病原学检查和病理活检结果。Objective:To investigate the clinical diagnosis and treatment characteristics of one case with pulmonary cryptococcosis misdiagnosed as pulmonary tuberculosis,and conduct literature review to provide reference for improving the understanding of pulmonary cryptococcosis.Methods:The patient was admitted to the hospital for treatment since pulmonary shadows were found during physical examination.The chest CT examination in another hospital showed"multiple patchy shadows with blurred edges in the upper lobe of the right lung,and a few patchy and speckled blurry shadows in the anterior basal segment of the lower lobe of the right lung",so the patient was clinically diagnosed with secondary tuberculosis.Results:After admission,the patient received the examinations,but the bronchoscopy showed no obvious abnormalities,and the tuberculin purified protein derivative(PPD)test showed negative results,so the diagnosis of pulmonary tuberculosis was ruled out;a transbronchial lung biopsy(TBLB)was performed.The lung tissues were taken for special staining,and the results were positive for methenamine silver staining and for mucicarmine staining.A small amount of fungal capsules were visible,which was consistent with the characteristics of cryptococcal infection,so fluconazole was given and and the patient's symptoms improved.Conclusion:For nodular pulmonary lesions,attention should be paid to the site of onset and the halo signs that are easily ignored,which are more common in the early stages of pulmonary mycosis.The clinical symptoms and imaging manifestations of pulmonary cryptococcosis are non-specific.When the lung lesions are mainly nodules and are located in the posterior segment of the upper lobe apex and the dorsal segment of the lower lobe,they are easily misdiagnosed as pulmonary tuberculosis.A definite diagnosis depends on the results of etiological examination and pathological biopsy.

关 键 词：肺隐球菌 肺结核 误诊 

分 类 号：R52[医药卫生—内科学] R447[医药卫生—临床医学]