肺移植后侵袭性肺曲霉菌病的诊治一例

Diagnosis and treatment of invasive pulmonary aspergillosis following lung transplantation: one case (report)

目的总结双肺移植后侵袭性肺曲霉菌病的诊疗体会。方法1例双肺移植患者,术后8个月肺部发生嗜麦芽寡养单胞菌和黄曲霉菌感染,胸部X线片显示双肺呈浸润性病变,以右肺为主,应用伊曲康唑抗曲霉菌治疗,应用头孢哌酮/舒巴坦抗嗜麦芽寡养单胞菌治疗。结果用药6d后痰真菌培养结果转阴,患者症状逐步好转;头孢哌酮/舒巴坦抗嗜麦芽寡养单胞菌治疗效果不佳,后换用替卡西林/克拉维酸后痰细菌培养转阴。在维持血他克莫司(FK506)浓度在有效水平的基础上,FK506的用量从6mg/d减至0.5mg/d。结论CT在侵袭性肺曲霉菌病诊断中的价值优于X线片;应用伊曲康唑治疗侵袭性肺曲霉菌病有效,同时应注意血FK506浓度的监测。

Objective To study the curative effectiveness of Itraconazole in the treatment of invasive pulmonary aspergillosis following bilateral lung transplantation. Methods One patients undergoing bilateral lung transplantation was readmitted at 8-month postoperatively due to cough, sputum, and fever. Sputum culture reported positive Aspergillus flavus. Chest X-ray manifested bilateral lung infiltration. Chest CT scan showed multiple small cavities, hraconazole （Sporanox） therapy was performed. Results Sputum smear and culture reported negative aspergillus at sixth of Itraconazole therapy. Patient＇s symptoms after ltraconazole treatment for 10 days were improved obviously, Chest CT scan showed the lung lesion still existed. After treatment by ltraconazole, FK506 dosage was decreased from 3 mg, twice a day to 0. 5 mg, once a day. Conclusion Pulmonary aspergillosis is an important complication following lung transplantation, ltraconazole therapy can effectively treat invasive pulmonary aspergillosis following bilateral lung transplantation. Blood drug concentration monitoring indicated the dosage of FKS06 was significantly decreased after hraconazole therapy.