原发性胆汁性胆管炎-自身免疫性肝炎重叠综合征合并肺隐球菌病1例报告  

Primary biliary cholangitis-autoimmune hepatitis overlap syndrome comorbid with pulmonary cryptococcosis:A case report

作　　者：张明明 刘寰 张冬梅[1] 吴东波[1] 唐红[1] ZHANG Mingming;LIU Huan;ZHANG Dongmei;WU Dongbo;TANG Hong(Laboratory of Infectious and Liver Diseases,Institution of Infectious Diseases,West China Hospital of Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院感染性疾病研究所,感染与肝病研究室,成都610041

出　　处：《临床肝胆病杂志》2024年第8期1666-1669,共4页Journal of Clinical Hepatology

基　　金：四川大学华西医院学科卓越发展1·3·5工程项目(ZYGD23030)。

摘　　要：自身免疫性肝病重叠综合征表现为患者出现一种以上的自身免疫性肝病的生化、免疫、组织学或胆管造影特征,常需联合使用免疫抑制剂治疗。肺隐球菌病是一种由新型隐球菌或格特隐球菌引起的侵袭性肺真菌病,易在免疫功能低下患者中发生。本病例为1例重叠综合征,在免疫抑制治疗过程中发现并治疗肺隐球菌病,在抗真菌治疗过程中肝功能出现异常,根据患者的肝功能情况,评估了更换抗真菌药物的可行性,综合考虑后制定了在密切监测肝功能的情况下,积极治疗新型隐球菌感染的治疗策略,避免了感染的进展。提示在启动免疫抑制治疗前,除了全面评估全身感染灶,对于可疑感染灶也必须保持监测。Patients with overlap syndrome(OS)of autoimmune liver disease may present with more than one biochemical,immunological,histological or cholangiography features of autoimmune liver disease(AILD)and often require a combination of immunosuppressants for treatment.Pulmonary cryptococcosis is a type of invasive pneumomycosis caused by Cryptococcus neoformans or Cryptococcus gattii and has a relatively high incidence rate in immunocompromised patients.This case report presents a patient with OS who was found to have pulmonary cryptococcosis during immunosuppressive therapy and developed abnormal liver function during antifungal treatment.Based on the liver function of the patient,the feasibility of adjusting antifungal agents was assessed,and active treatment strategies for novel cryptococcal infection were developed under the close monitoring of liver function,which helped to avoid the progression of infection.It is suggested that before the initiation of immunosuppressive therapy,systemic foci of infection should be comprehensively evaluated,and suspicious foci of infection should be monitored continuously.

关 键 词：肝炎 自身免疫性 原发性硬化性胆管炎 隐球菌属 肺疾病 真菌性 

分 类 号：R575[医药卫生—消化系统] R519.4[医药卫生—内科学]