肺隐球菌病合并多发骨质、皮肤损害1例并文献复习  

Pulmonary cryptococcosis with multiple bone and skin lesions:a case report and literature review

作　　者：赵阳阳 李平 闫玉杰 冯友繁[1] 魏小芳 伏媛[1] 黄秀娟[1] 李青芬 张启科[1] ZHAO Yangyang;LI Ping;YAN Yujie;FENG Youfan;WEI Xiaofang;FU Yuan;HUANG Xiujuan;LI Qingfen;ZHANG Qike(Department of Hematology,Gansu Provincial Hospital.Lanzhou 730000,China;Jingning County Hospital of Traditional Chinese Medicine,Jingning,China)

机构地区：[1]甘肃省人民医院血液科,兰州730000 [2]静宁县中医医院内科,静宁743400

出　　处：《中国真菌学杂志》2023年第6期521-524,共4页Chinese Journal of Mycology

基　　金：甘肃省科技计划项目(22JR5RA660,22JR11RA258);甘肃省人民医院院内科研基金项目(21GSSYC-14)。

摘　　要：探讨肺隐球菌病的临床表现及诊治,报道1例合并多发骨质破坏、皮肤损害肺隐球菌病的临床表现及诊疗经过,并结合国内外报道进行文献分析。患者,男,36岁,因胸闷气短伴骨痛、多发皮疹,以肺肿物收住入院,CT提示疑似肺部肿瘤病变、多发肋骨、椎骨骨质破坏;PET-CT提示全身多发骨质破坏、并胸椎及肋骨多处骨折,肺部病变符合炎症改变。CT引导下经皮肺穿刺、骨穿刺活检确诊为肺隐球菌病;同时血清蛋白电泳及血清免疫固定电泳弱阳性。行骨髓穿刺活检、免疫组化、染色体分析等相关化验检查后排除多发性骨髓瘤。给予氟康唑治疗,患者临床症状及影像学检查均明显好转。合并多发性骨质破坏及皮肤损害的肺隐球菌病例少见,确诊手段主要为病理活检,容易与肿瘤性疾病混淆,应引起临床医师关注。Objective A case of pulmonary cryptococcosis with multiple bone destruction and skin damage was reported,and literatures was reviewed.A 36-year-old man was admitted to the hospital with lung mass because of chest tightness,shortness of breath,bone pain and multiple rashes.CT showed suspected lung tumor lesions,multiple ribs and vertebral bone destruction.PET-CT showed multiple bone destruction throughout the body,with multiple fractures of thoracic vertebrae and ribs,and lung lesions were consistent with inflammatory changes.CT-guided percutaneous lung biopsy and bone biopsy were confirmed as pulmonary cryptococcosis,while serum protein electrophoresiSand serum immunofixation electrophoresis were weakly positive.Bone marrow biopsy,immunohistochemistry,chromosome analysis and other relevant laboratory tests were performed to exclude multiple myeloma.Fluconazole was given and the clinical symptoms improved.Pulmonary cryptococcosis complicated with multiple bone destruction and skin damage was rare and was easy to be confused with tumor disease.The diagnosis method is mainly pathological biopsy.

关 键 词：肺隐球菌病 肺肿物 骨质破坏 多发性骨髓瘤 

分 类 号：R519.4[医药卫生—内科学]