CAJ | 학술논문

目的：提高临床医师对原发性肺隐球菌病（pulmonary cryptococcosis，PC）的认识。方法对1例确诊为原发性肺隐球菌病患者的临床资料进行分析，并结合文献复习。结果患者男性，29岁，以“咳嗽、咳痰1月，气促22天”为主诉于2014年7月12日收住福建省立医院呼吸内科。于外院查胸部CT示双肺胸膜下多发结节、团片影伴空洞形成，经支气管镜活检病理检查提示肺隐球菌病，经氟康唑抗真菌治疗效果欠佳。入院后再行经皮肺穿刺病理及组织培养均证实肺隐球菌病，评估病情考虑重症PC，予两性霉素B脂质体联合5-氟胞嘧啶诱导治疗1月后改用氟康唑巩固治疗，临床症状缓解，复查肺部病灶明显吸收。结论原发性肺隐球菌病缺乏特异性的临床和影像学表现，容易误诊、误治。确诊主要依靠病理和病原学检查，经皮肺穿刺活检是值得推荐的获取组织标本的手段。重症肺隐球菌病患者少见，获得组织病理诊断的同时应积极争取行组织培养及药敏试验，治疗方案应参照中枢神经系统感染。
목적：제고림상의사대원발성폐은구균병（pulmonary cryptococcosis，PC）적인식。방법대1례학진위원발성폐은구균병환자적림상자료진행분석，병결합문헌복습。결과환자남성，29세，이“해수、해담1월，기촉22천”위주소우2014년7월12일수주복건성립의원호흡내과。우외원사흉부CT시쌍폐흉막하다발결절、단편영반공동형성，경지기관경활검병리검사제시폐은구균병，경불강서항진균치료효과흠가。입원후재행경피폐천자병리급조직배양균증실폐은구균병，평고병정고필중증PC，여량성매소B지질체연합5-불포밀정유도치료1월후개용불강서공고치료，림상증상완해，복사폐부병조명현흡수。결론원발성폐은구균병결핍특이성적림상화영상학표현，용역오진、오치。학진주요의고병리화병원학검사，경피폐천자활검시치득추천적획취조직표본적수단。중증폐은구균병환자소견，획득조직병리진단적동시응적겁쟁취행조직배양급약민시험，치료방안응삼조중추신경계통감염。
ObjectiveTo improve the awareness of primary pulmonary cryptococcosis(PC). Method One case of primary pulmonary cryptococcosis was analysed and relevant literatures were reviewed.Result A 29-year-old male patient was admitted to the hospital on July, 2014 because of cough and expectoration for a month and dyspnea for 22 days.The lung CT showed multiple subpleural patchy or mass shadows within the both lungs. The bronchial lung biopsy has confirmed the dianogsis.Fluconnazole was given intravenously for 2 weeks but failed. A percutaneous lung biopsy and a pathological examination were performed to comfirm the diagnosis of PC again.The patient was reevaluated and considered as severe condition. Amphotericin B plus 5-fluorine cytosine were used for 1 month and followed by fluconazole as the antifungal therapy.The patient’s condition was alleviated and the lung lesion was significantly absorbed.Conclusion Primary pulmonary cryptococcosis lacking in specificities of clinical and imaging findings is easily misdiagnosed and mistreated.Prompt lung biopsy and pathology with special stains can confirm the diagnosis. Less invasive percutaneous lung biopsy is recommended. As severe condition was less commonly seen in PC patients, clinicians should strive to obtain tissue cultures and perform a sensitivity test.Antifungal therapy should refer to the cryptococcus neoformans meningitis treatment.