天疱疮合并肺部奔马赭霉暗色丝孢霉病一例的诊断及治疗

Pemphigus patient with pulmonary fungal infection caused by Ochroconis gallopava:the first case report in China

目的 介绍 1例寻常型天疱疮患者合并肺部奔马赭霉 (Ochroconisgallopava)暗色丝孢霉病感染后的诊断及治疗经验。方法 对寻常型天疱疮肺部损害 1例患者在CT指导下行肺部空洞穿刺 ,穿刺物在沙氏培养基上进行真菌培养。患者经两性霉素B脂质体、伊曲康唑等抗真菌治疗。结果 (1)菌落特征 :4管均长出同样丝状真菌 ,镜下形态相同 ,菌落表面绒毛状、棕绿色 ,培养基背面可见弥漫红褐色色素。 (2 )显微镜下观察 :菌丝较粗大分隔 ,分生孢子棒状 ,一端较宽 ,大多由两个细胞组成 ,分生孢子脱落后可见凹痕。该真菌经美国疾病控制中心鉴定为奔马赭霉。患者经系统抗真菌治疗后 ,肺部空洞明显缩小 ,症状减轻。约 1年后空洞纤维化。结论 奔马赭霉引起肺部暗色丝孢霉病在我国为首例报道。两性霉素B脂质体治疗本病疗效显著。

Objective To report a case of pemphigus complicated by pulmonary infection due to Ochroconis gallopava, the first such case in China. Methods A male pemphigus patient with pulmonary symptoms, aged 68, received a needle biopsy under CT scan. The materials obtained from the lung cavity were cultured on Sabouraud dextrose agar in four test tubes. Results Fungal colonies of the same characteristics grew on the slant of the 4 test tubes 3 days after culture. The colonies were brown-green with a downy surface. Diffuse red-brown pigment was seen in the reverse side of the culture medium. Microscopy revealed septate and clavate mycelia and two-celled conidia with the apical cell being wider than the basal cell. The fungus was identified as Ochroconis gallopava by Dr A.A. Padhye (CDC). Amphotericin B liposome was given at hte dose of 50～75～100 mg/d for more than one month Then itraconazole was given for about one year. The cavity in the lung became smaller in diameter and the symptoms were ameliorated soon after pharmacotherapy. Examination about one year later showed fibrosis. Conclusion Case of pulmonary fungal infection caused by Ochroconis gallopava has been reported for the first time in China. Amphotericin B liposome has good effect on infection of Ochroconis gallopava.