隐球菌肺炎误诊肺结核一例并文献复习

目的探讨隐球菌肺炎的临床特点,提高对隐球菌肺炎的认识。方法报道1例误诊为继发性肺结核的隐球菌肺炎的诊治经过。结果患者男性,32岁,因反复咳嗽、咳痰3月,规范抗结核治疗1月,咳嗽、咳痰无改善入院。实验室检查:经皮肺穿刺活检病理提示真菌感染,支气管肺泡灌洗液培养见新型隐球菌生长,对两性霉素、氟康唑、伏立康唑敏感。予氟康唑抗真菌治疗2周后,患者病情明显好转。结论隐球菌肺炎的临床症状与影像学表现无特征性,确诊需依靠病原学检查及病理活检。

Pulmonary cryptococcosis misdiagnosed as tuberculosis: case report with a literature review

Objective To discuss the features of pulmonary cryptococcosis,and improve the diagnosis and treatment.Methods A case of pulmonary cryptococcosis reported,misdiagnosed as secondary pulmonary tuberculosis.Results A 32 years old male patient,who had chronic cough/expectoration for 3 months,had no improvement after received standard antituberculous therapy for a period of 1 month.Lab tests showed that percutaneous lung pathology diagnosis was fungal infection;Cryptococcus neoformans grew in bronchoalveolar lavage fluid,sensitive to amphotericin B,fluconazole,voriconazole.After 2 weeks of antifungal therapy with fluconazole,the symptoms of the patient was obviously improved.Conclusion The clinical manifestations and imaging findings of pulmonary cryptococcosis are not characteristic.So,the diagnosis is mainly dependent on etiological examination and pathology biopsy.