烟曲霉白化株致免疫正常宿主肺曲霉球

An albino strain of Aspergillus fumigatus causes pulmonary aspergilloma in an individual with normal immune ;system

患者女，76岁，因右侧胸痛3个月就诊。肺部CT示右侧下叶背段4.8 cm ×3.0 cm团块状密度增高影。取患者肺穿刺组织进行真菌培养及组织病理检查。组织病理显示慢性肉芽肿性炎，有隔的透明菌丝。SDA培养见白色绒毛状致密菌落，中央略高起，表面可见皱褶或放射状纹，背面呈淡黄色，小培养见较丰富的分枝分隔菌丝，可见极少量无色透明类圆形孢子。对分离菌种行rDNA ITS、β微管蛋白测序鉴定及抗真菌药物体外药敏试验，利用MEGA7.0软件构建烟曲霉复合体及其近源菌种系发生树。分子生物学测序鉴定为烟曲霉。诊断：肺曲霉球。先后予以伊曲康唑口服液及伏立康唑片治疗后明显好转。

A 76-year-old female patient complained of right chest pain for three months. CT scan showed a clump-like high-density shadow measuring 4.8 cm × 3.0 cm in size in the dorsal portion of the right lower lobe of the lung. Aspiration biopsy was performed, and biopsy samples were subjected to fungal culture and histopathological examination. Histopathological examination showed chronic granulomatous inflammation with hyaline septate hyphae. After 4-day culture, white villous dense colonies were formed on the Sabouraud′s agar medium. The center of the colonies was slightly elevated with wrinkles or radiating striae on the surface, and the bottom of the colonies was faint yellow in color. Microculture yielded abundant septate branched hyphae, and very few colorless hyaline quasi-circular spores. DNA sequencing of rDNA internal transcribed spacer （ITS） regions and β-tubulin genes was performed to identify the isolate, and antifungal susceptibility testing was carried out in vitro. The MEGA7.0 software was used to build phylogenetic trees of Aspergillus fumigatus complex and its closely related species. The isolate was identified as Aspergillus fumigatus by molecular biologic sequencing. The patient was diagnosed with pulmonary aspergilloma. After administration of itraconazole oral solution and vorionazole tablets, the condition got better obviously.