孕产妇感染侵袭性肺曲霉病1例并文献复习

A case report of invasive pulmonary aspergillosis in pregnant women and literature review

目的提高对孕产妇罹患侵袭性肺曲霉病的认识。方法结合1例侵袭性肺曲霉病孕产妇患者的临床资料及诊治经过并复习相关文献,对侵袭性肺曲霉病的临床表现、影像学特点、诊断要点及治疗进行分析。结果患者女,27岁,孕产妇,因咳嗽、咳痰、呼吸困难伴发热半个月于2011年4月18日入我院呼吸内科。患者半个月前(临产前1d)突发咳嗽、咳痰、呼吸困难伴高热,在当地医院住院给予多种抗生素治疗,但病情无好转且喘息加重而紧急转入我院。入院后病情危重,影像显示双肺多发性侵袭性空洞,5次痰分离出烟曲霉菌,纤支镜刷检物培养出烟曲霉菌。在积极支持治疗和对症处理的基础上,先后给予伏立康唑、伊曲康唑、两性霉素B、卡泊芬净治疗4个月,复查双肺CT影像明显吸收、空洞愈合,患者康复出院。结论随着人口老龄化及免疫抑制剂的广泛应用,侵袭性肺曲霉病目前已不少见,相关报道亦较多,但孕产妇感染本病、病情进展凶险且被成功救治的病例目前尚未见报道,此报道一例。

Objective To improve the cognition of invasive pulmonary aspergillosis in pregnant women. Methods By analyzing a case of pregnant women suffering from severe invasive pulmonary aspergillosis and liter- ature review, this paper summarized the clinical manifestation, imaging feature, diagnosis main point and treat- ment of severe pulmonary aspergillosis. Resolts A 27 years old pregnant woman suffering from cough, expectora- tion and dyspnoea with pyrexia was admitted in our hospital in April 18, 2011. The patient began to cough, expec- toration and dyspnoea 15 days before admitting （just one day before child bearing） with ardent fever. There was not any releasing when treated in local hospital with intensive antibiotics, instead the symptoms became progres- sively more severe, so the patient came to our hospital for proper management. When admitted in our hospital, the condition of this patient was very urgent, several cavities could be found in lung CT screenage. Aspergillus fumig- atus was characterized from patient sputum 5 times and Aspergillus fumigatus grew in cultivated liquid got from bronchofibroscope brush. Combined with active supplying treatment, voriconazole, itraconazole, amphotericin B and caspofungin were applied for four months. The patient finally recovered from this severe pneumonia, with CT showing lung shadow disappearance and closed cavities. Conclusion With the coming of aging and immuno- suppressor, invasive pulmonary aspergillosis is not very rare. However, there is not a report about pregnant women suffering from severe invasive pulmonary asporgillosis and is successfully saved. Here we have provided such a case.