肺隐球菌病并发纵隔淋巴结结核误诊一例——病例报告及文献复习

A case of pulmonary cryptococcosis with mediastinal tuberculous lymphadenitis report of case and review of literature

肺隐球菌病是一种吸入隐球菌孢子而引起的肺急性、亚急性或慢性真菌病,易播散至中枢神经系统而导致隐球菌性脑膜炎,病死率和致残率高。近年肺隐球菌病的发病率呈增长趋势。肺隐球菌病的临床症状及体征、肺部影像学及实验室检查均缺乏特异性,因此极易漏诊、误诊。河北省胸科医院病理科近期会诊一例肺隐球菌病并发纵隔淋巴结结核患者,曾在外院就诊时经影像学及临床检查误诊为肺癌,术后病理误诊为肺结核,经我院会诊其病理切片及进行辅助检查（特殊染色、结核分枝杆菌核酸检测）后最终明确诊断。现结合相关文献回顾性分析其临床、影像及病理特点,以期提高其诊断水平,避免误诊误治。

Pulmonary cryptococcosis is an acute, subacute or chronic pulmonary fungal disease caused by inhaling cryptococcus spores, and often disseminates to the central nervous system and results in cryptococcal meningitis. Recent studies show that the incidence of pulmonary cryptococcosis is increasing. The clinical symptoms, chest imaging and laboratory examinations for pulmonary cryptococcosis are not specific and these cases are often misdiagnosed. A patient with pulmonary cryptococcosis complicated with mediastinal tuberculous lymphadenitis was recently consulted in Hebei Chest Hospital. This case was misdiagnosed as lung cancer according to imaging and clinical symptoms in other hospital, and then misdiagnosed as tuberculosis after surgery. The diagnosis was confirmed after the pathological consultation and related examination in our hospital. The clinical, imaging and pathological features were analyzed retrospectively based on relevant literature to improve the diagnostic level and avoid misdiagnosis and mistreatment.