自身免疫性大疱病合并侵袭性肺曲霉病:3例报告

Invasive pulmonary aspergillosis in autoimmune bullous diseases patients:three cases report

目的通过典型病例回顾探讨自身免疫性大疱病糖皮质激素治疗过程中合并肺曲霉病的诊断和治疗情况。方法报告3例自身免疫性大疱病合并侵袭性肺曲霉病病例。3例病例均行痰镜检、培养、抗原检测、胸部CT或者坏死组织病理检查。分离病原菌经形态学和分子生物学鉴定为烟曲霉、黄曲霉和刺孢裸胞壳。结果 3例病例证实为侵袭性肺曲霉病。进行以伏立康唑为主的综合治疗后均治愈。结论自身免疫性大疱病糖皮质激素治疗过程中应警惕肺曲霉病的发生。多种实验室检查可以帮助早期诊断,提高疗效。

Objective To study the diagnosis and treatment of invasive pulmonary aspergillosis in autoimmune bullous diseases patients under long-term glucocorticoids treatment by retrospectively reviewing three cases. Methods Report three cases of autoim- mune bullous diseases with invasive pulmonary aspergillosis. KOH smear and culture, antigen detection, chest CT scan and his- topathologic test were used to diagnose the patients. The organisms isolated from the sputum were identified as Aspergillus fumigatus,A.flavus and Emericella echinulata by morphological and molecular methods. Results Three cases were diagnosed as in- vasive pulmonary aspergiltosis. The patients were cured with voriconazole treatment and other antifungal agents. Conclusion Auto- immune bullous diseases patients should be watched out emerging invasive apergillosis during long-term glucocorticoids therapy. Combined laboratory examinations will be helpful in early diagnosis and increasing efficacy.