原发性肺隐球菌病例报告及文献复习

目的:探讨肺隐球菌病的临床及病理特点,提高对肺隐球菌病的认识,以减少误诊。方法:回顾性分析1例原发性肺隐球菌病的诊断和治疗经过,分析总结治疗经验,结合文献复习肺隐球菌病的发病机制、临床表现、诊断与治疗要点。结果:患者男性,56岁,有糖尿病史,胸部影像学检查发现右肺内胸膜下多发性片状或团块状阴影,给予抗生素治疗无效,曾怀疑为肺癌行经皮肺活检提示肺隐球菌病,入我院进一步诊治。病理检查提示肉芽肿形成,可见隐球菌孢子,高碘酸希夫染色(PAS)和六胺银染色均阳性,确诊原发性肺隐球菌病。给予氟康唑400 mg/d,静脉滴注,6 w后病灶明显吸收,改为氟康唑口服出院。结论: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。临床医生需要提高对肺隐球菌病的认识,尽可能行病理检查结合特殊染色明确诊断。标本来源以创伤小的经皮肺穿刺为首选,治疗前需全面评估病情。

Primary pulmonary cryptococcosis: a case report and literature review

Objective:To investigate the clinical and pathological features of pulmonary cryptococcosis,improve the understanding of pulmonary cryptococcosis and reduce misdiagnosis in clinical scenario.Methods: Retrospectively analyzed the diagnosis and treatment of one patient with primary pulmonary cryptococcosis,reviewed the literature and summarized the pathogenesis,clinical manifestations,diagnosis and treatment of pulmonary cryptococcosis.Results: A male patient,56 years old,had a basis disease of diabetes,due to the attack of Meniere’s syndrome,he went to hospital,chest X-ray Photography showed multiple subpleural patchy or mass shadows within the right lung.Ordinary empirical anti-bacterial therapy failed and percutaneous-needle lung biopsy was performed because of suspicion of lung cancer.The patient was admitted into hospital because fever and cough after lung biopsy.Pathological examinations showed granuloma formation with C.neoformans spores,PAS and methenamine silver staining were positive.The diagnosis of primary pulmonary cryptococcosis was conformed.Fluconazole 400mg / day was given intravenously for 6 weeks when the lung lesion was significantly absorbed and fluconazole was switched to oral administration.The patient was discharged and recommended him to continue to use fluconazole for at least 6 months.Conclusion:Pulmonary cryptococcosis is lack of specificities of clinical and imaging findings and easily to be misdiagnosed and mistreated.Clinician should with alert in suspected patient.Prompt lung biopsy and pathology with special stains can confirm the diagnosis.Less invasive percutaneous lung biopsy is the preferred.Antifungal therapy should be initiated after a comprehensive assessment of this condition.