上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 病例报告 • 上一篇    

无免疫缺陷侵袭性曲霉气管-支气管炎合并支气管肺炎1例报道

黄静，沈庆，文秀芳，陈元澜，尹长春，陈小容   

  1. 重庆市第三人民医院呼吸内科， 重庆 400014
  • 出版日期:2015-07-28 发布日期:2015-08-27
  • 通讯作者: 沈庆, 电子信箱: 2582368108@qq.com。
  • 作者简介:黄静（1976—）， 女， 副主任医师， 硕士生; 电子信箱: huangjing527@hotmail.com。

Report of a case of invasive aspergillus tracheobronchitis combined with alveobronchiolitis and without immune deficiency

HUANG Jing, SHEN Qing, WEN Xiu-fang, CHEN Yuan-lan, YIN Chang-chun, CHEN Xiao-rong   

  1. Department of Respiratory Medicine, the Third People’s Hospital of Chongqing, Chongqing400014, China
  • Online:2015-07-28 Published:2015-08-27

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摘要：

目的  探讨侵袭性曲霉气管-支气管炎（IATB）合并支气管肺炎的临床特点，提高对本病的认识。方法  报道分析1例无免疫缺陷IATB合并支气管肺炎患者的临床资料，复习文献探讨其临床表现及支气管镜特点。结果  患者，女，46岁，因声音嘶哑10 d，加重伴呼吸困难6 d入住耳鼻喉科。门诊纤维喉镜检查示双侧声门下见白色假膜样附着，入院后肺CT示右肺中叶不张，右肺中、下叶见不规则片状密度增高影，入院第2日因呼吸困难加重转入呼吸内科，纤维支气管镜检查距声门2～3 cm气道周围可见较多白色附着物，病理检查见大量曲霉菌菌丝，诊断IATB伴肺炎明确，予以伏立康唑抗真菌治疗，1个月后患者症状基本消失，病灶吸收。复习国内外文献报道IATB主要发生于严重免疫缺陷患者，亦可侵犯轻度免疫功能低下及健康宿主。结论  提高对轻度及无免疫缺陷者侵袭性曲霉病的认识，并对不明原因剧烈咳嗽及呼吸困难患者应将IATB作为一个可能的诊断，尝试及时诊断程序，尽早行纤维支气管镜检查等明确诊断，对获得的气管-支气管假膜进行组织学检查，支气管肺泡灌洗液（BALF）进行PCR检查更有助于提高阳性率。

关键词: 侵袭性曲霉气管-支气管炎, 支气管镜检查, 诊断

Abstract:

Objective  To explore the clinical characteristics of invasive aspergillus tracheobronchitis (IATB) combined with alveobronchiolitis and improve the understanding of this disease. Methods  Clinical data of an IATB patient with alveobronchiolitis and without immune deficiency was reported and analyzed. Literature was reviewed to investigate the clinical manifestations and bronchoscopic characteristics. Results  A 46 year-old female patient was admitted to the tolaryngology department due to hoarseness for 10 d and aggravation of breathing difficulty for 6 d. Clinical fiberoptic examination showed that white pseudomembrane attached to bilateral subglottis. Lung CT showed right middle lobe atelectasis and irregular flake density shadow in right middle lobe and lower lobe. On the second day of admission, the patient was transferred to the Department of Respiratory Medicine due to dyspnea. Bronchoscopy examination discovered more white attachment around the main airways 2-3 cm from glottis. Pathological examination showed a large number of Aspergillus hyphae and the patient was diagnosed with IATB combined with pneumonia. After 30 d of treatment by voriconazole, the symptoms of patient almost disappeared and the focus was absorbed. Literature review indicated that most IATB patients were ones with serious immune deficiency and IATB could also invade people with mild low immune function and health people. Conclusion  The awareness of people with mild or no immune deficiency who develop invasive aspergillosis should be improved. If the reason of severe coughing and dyspnea of patients is unknown, IATB is a possible diagnosis. Timely diagnosis procedure should be performed and bronchoscopy examination should be conducted ASAP to determine the diagnosis. Tracheobronchial pseudomembrane should be histologically examined and bronchoalveolar lavage fluid (BALF) should be examined by PCR in order to improve the positive rate.

Key words: invasive aspergillus tracheobronchitis, bronchoscopy, diagnosis