弥漫大B细胞淋巴瘤合并肺隐球菌病1例并文献复习  

Diffuse large B-cell lymphoma with pulmonary cryptococcosis:report of 1 case and review of literature

作　　者：林彩芹 王素丽 潘韶英 谢东升 田苗苗 宋蕾娜 凌慧君 时会贞 朱斌[1] 丁志勇[1] 赵文理[1] Lin Caiqin;Wang Suli;Pan Shaoying;Xie Dongsheng;Tian Miaomiao;Song Leina;Ling Huijun;Shi Huizhen;Zhu Bin;Ding Zhiyong;Zhao Wenli(Department of Hematology,the Central Hospital of Fengxian District of Shanghai,South Campus of the Sixth Hospital of Shanghai Jiao Tong University,Shanghai 201400,China;Department of Imaging,the Central Hospital of Fengxian District of Shanghai,South Campus of the Sixth Hospital of Shanghai Jiao Tong University,Shanghai 201400,China)

机构地区：[1]上海交通大学附属第六人民医院南院上海市奉贤区中心医院血液科,上海201400 [2]上海交通大学附属第六人民医院南院上海市奉贤区中心医院影像科,上海201400

出　　处：《白血病.淋巴瘤》2025年第3期155-158,共4页Journal of Leukemia & Lymphoma

基　　金：上海市奉贤区第二批临床诊疗中心建设项目(fxlczlzx⁃a⁃202105)。

摘　　要：目的提高对弥漫大B细胞淋巴瘤(DLBCL)患者合并肺隐球菌病的认识。方法回顾性分析上海市奉贤区中心医院2023年5月收治的1例DLBCL合并肺隐球菌病患者的临床资料,并复习相关文献。结果患者,女性,75岁。在接受R⁃CHOP方案化疗2个疗程后,无临床症状,肺部高分辨CT发现肺部结节并进行性增大,抗细菌治疗无效;经肺泡灌洗液(BALF)靶向高通量测序(tNGS)及隐球菌荚膜抗原(CrAg)检测确诊肺隐球菌病,未累及中枢神经系统。给予足剂量氟康唑长疗程治疗6个月,并同步完成抗淋巴瘤治疗;抗真菌治疗1个月肺部结节病灶缩小,末次化疗结束半年后随访,肺部结节消失,淋巴瘤评估处于完全缓解状态。结论肺隐球菌病发生隐匿,无特异症状,影像学表现多变且常规抗感染无效,淋巴瘤患者免疫化疗为隐球菌感染的高危因素。BALF行tNGS和CrAg检测是确诊的有效手段,早期、足剂量、长疗程抗真菌治疗,是防止感染进展或复发的关键。Objective To improve the understanding of patients with diffuse large B-cell lymphoma(DLBCL)with pulmonary cryptococcosis.Methods The clinical data of 1 DLBCL patient with pulmonary cryptococcosis in the Central Hospital of Fengxian District of Shanghai in May 2023 were retrospectively analyzed,and the relevant literatures were reviewed.Results This 75-year-old female patient was asymptomatic after 2 cycles of R-CHOP chemotherapy.The high-resolution CT of lung showed that lung nodules were progressively enlarged.Antibacterial treatment was ineffective.Pulmonary cryptococcosis was confirmed by bronchoalveolar lavage fluid(BALF)targeted highthroughput sequencing(tNGS)and cryptococcus capsular antigen(CrAg)detection.The central nervous system was not involved.And the long-term adequate-dose fluconazole was prescribed for 6 months,and the treatment against lymphoma was given synchronously.The lung nodule lesions reduced after antifungal therapy for 1 month.The lung nodules disappeared after the follow-up of 6 months after completion of final chemotherapy.The evaluation of lymphoma indicated complete remission.Conclusions Pulmonary cryptococcosis occurs insidiously and shows no specific symptoms;its imaging manifestations are variable and routine anti-infection is ineffective.Immunochemotherapy for lymphoma patients is a high-risk factor for cryptococcal infection.tNGS and CrAg testing for BALF are effective methods of the confirmed diagnosis.The early and long-term adequate-dose antifungal treatment is the key to preventing the recurrence or progression.

关 键 词：淋巴瘤 大B细胞 弥漫性 免疫疗法 肺隐球菌病 

分 类 号：R733.4[医药卫生—肿瘤]