肺结节病合并肺隐球菌病的临床特点分析

Clinical characteristics of pulmonary sarcoidosis complicated with pulmonary cryptococcus

目的探索肺结节病合并肺隐球菌病患者的临床特点,提高对该病临床情况的认识。方法报道1例北京医院收治的肺结节病合并肺隐球菌病例,该患者通过肺穿刺诊断肺结节病Ⅱ期。在口服糖皮质激素治疗过程中肺内新出现结节影,结合患者病史、影像学、血清隐球菌多糖夹膜抗原(CrAg)及对治疗的反应,考虑为肺结节病合并肺隐球菌病;同时进行文献回顾,检索截至2024年4月国内外报道的肺结节病合并肺隐球菌病病例资料的相关文献,对该病临床情况的流行病学特征、临床表现、诊断、治疗及预后信息进行总结分析。丝结果共获文献7篇,包含8例肺结节病合并肺隐球菌病例,连同本例复习病例共9例,其中55.6%(5/9)为男性,诊断肺结节病的平均年龄为51岁,其中1/3患者为老年人,肺结节病分期均为I期和Ⅱ期。8例患者(88.9%、8/9)在诊断隐球菌病时正在接受糖皮质激素或其他免疫抑制剂治疗。在所有报道了隐球菌病诊断方法的病例中,血清CrAg均为阳性,包括3例老年患者。有1例患者因病情迅速恶化未接受抗真菌治疗。在随访至少6个月时,所有接受治疗的患者均临床稳定,氟康唑是最常选择的抗真菌药。结论肺结节病并发隐球菌感染的病例报道罕见,但临床医生应始终考虑这种可能性,这两种情况可能有重叠的临床表现,且在治疗策略上可能相互矛盾,若出现误诊漏诊,可能导致严重的临床结局,血清CrAg有助于协助诊断,尤其是对于老年人群。

Objective To explore the clinical characteristics of patients with pulmonary sarcoidosis complicated by pulmonary cryptococcosis,thereby enhancing the understanding of this clinical scenario.Methods We report a case of pulmonary sarcoidosis complicated by pulmonary cryptococcosis treated at Beijing Hospital.The patient was diagnosed with stage I pulmonary sarcoidosis via CT-guided percutaneous fine needle aspiration lung biopsy.However,during treatment with oral prednisone,a chest CT scan revealed newly developed multiple nodules in the right lower lobe.By considering the patient's medical history,imaging results,cryptococcal antigen(CrAg)levels,and treatment response,a diagnosis of pulmonary sarcoidosis complicated by pulmonary cryptococcosis was established.Additionally,we systematically reviewed the literature on pulmonary sarcoidosis complicated by pulmonary cryptococcosis published before April 2024,focusing on epidemiological characteristics,clinical manifestations,diagnosis,treatment,and prognosisR.esultsA total of seven articles were obtained,and nine cases were reviewed in conjunction with this case.Among these,55.6%(5/9)of the patients were male,with an average age of 51 years,and one-third of the patients were categorized as elderly.The stages of pulmonary sarcoidosis identified were stage I and stage II.Eight patients(88.9%,8/9)were receiving glucocorticoids or other immunosuppressants at the time of cryptococcosis diagnosis.In the cases that specified the diagnostic method for cryptococcosis,serum cryptococcal antigen(CrAg)was found to be positive,including in three elderly patients.One patient did not receive antifungal treatment due to the rapid deterioration of his condition.During a follow-up period of at least six months,all patients remained clinically stable,with fluconazole being the most chosen antifungal agent.Conclusions Although cases of pulmonary sarcoidosis complicated by cryptococcal infection are rare,clinicians should remain vigilant to this possibility.The two conditions mayy exhibit overlapping clinical manifestations,yet their treatment strategies can be contradictory.Misdiagnosis and delayed diagnosis could result in serious clinical consequences.Serum CrAg testing is particularly useful for diagnosis,especially in elderly patients.