免疫功能正常肺隐球菌病的特殊影像学表现1例并文献复习  

A case of immunocompetent pulmonary cryptococcosis with special imaging findings and literature review

作　　者：牛莉娅 李越辉 耿瑞慧 吴怀玉 周辉芳 NIU Liya;LI Yuehui;GENG Ruihui;WU Huaiyu;ZHOU Huifang(The First Mobile Corps Hospital of Chinese People's Armed Police Force,Dingzhou,Hebei 073000,China;The 980th Hospital of PLA Joint Logistics Support Force,Shijiazhuang,Hebei 050082,China)

机构地区：[1]武警第一机动总队医院,河北定州073000 [2]联勤保障部队第九八〇医院,河北石家庄050082

出　　处：《中国热带医学》2024年第9期1089-1093,共5页China Tropical Medicine

基　　金：2021年度河北省医学科学研究课题计划项目(No.20211094);石家庄市科学技术研究与发展计划项目(No.201200533)。

摘　　要：通过对少见临床病例的分析及文献复习,旨在提高对免疫功能正常肺隐球菌病特殊影像学表现的认识,减少误诊和漏诊。本文1例合并肺动脉高压和新型冠状病毒感染恢复期核酸弱阳性的免疫功能正常的肺隐球菌病病例,其肺部CT表现为罕见的类似肺间质改变的特点,通过查阅文献对肺隐球菌病的临床症状、影像学表现、诊断、治疗转归进行探讨复习。该患者重度主动脉瓣狭窄需尽快手术治疗,继发肺部感染,亚急性起病,临床表现无特异性,病初经验性抗感染治疗效果欠佳,及时完善检查明确病原体主要为新型隐球菌,给予抗真菌治疗,为手术争取了机会,达到了良好的治疗效果。通过查阅文献,罕见免疫功能正常的肺隐球菌病患者肺部CT表现为类似肺间质改变的特点。肺隐球菌病临床症状无特异性,影像学表现多种多样,易混合感染,需引起高度重视;本例患者免疫功能正常,肺部CT却表现为类似免疫缺陷患者肺隐球菌病影像改变的特点,其致病机制尚待进一步探讨。To improve the understanding of the special imaging features of pulmonary cryptococcosis in immunocompetent individuals and reduce misdiagnosis and missed diagnosis through the analysis of rare clinical cases and literature review.We reported a case of normal immunocompetent pulmonary cryptococcosis with pulmonary hypertension and COVID-19 weak positive nucleic acid during convalescence,CT scan of the lungs revealed rare features similar to pulmonary interstitial changes.Literature was reviewed to further discuss pulmonary cryptococcosis's clinical symptoms,imaging manifestations,diagnosis,and treatment outcome.The patient with severe aortic stenosis needed to be treated by surgery as soon as possible.Secondary pulmonary infection,subacute onset,and clinical manifestations were nonspecific,and empirical anti-infection treatment at the beginning of the disease was not effective.The timely revision of the examination confirmed that the predominant causative agent was Cryptococcus neoformans,and prompt administration of antifungal treatment facilitated surgical intervention and yielded favorable therapeutic outcomes.Literature review revealed that it is rare for pulmonary cryptococcosis in immunocompetent patients to present with pulmonary interstitial changes on CT findings.Pulmonary cryptococcosis presents with non-specific clinical symptoms and diverse imaging features,making it prone to mixed infection and requiring high vigilance.In this case,the immunocompetent patient's pulmonary CT findings exhibited changes resembling those in immunodeficient patients with pulmonary cryptococcosis.The underlying pathogenic mechanism needs to be further explored.

关 键 词：肺隐球菌病 新型隐球菌 免疫功能正常 肺动脉高压 肺间质改变 

分 类 号：R519.4[医药卫生—内科学]