自身免疫性大疱病合并侵袭性肺曲霉病:3例报告

中国真菌学杂志　 2012, Vol. 　Issue (4): 214-218.

自身免疫性大疱病合并侵袭性肺曲霉病:3例报告

余进¹, 牟向东², 万喆¹, 阙呈立², 李若瑜¹

1. 北京大学第一医院皮肤性病科北京大学真菌和真菌病研究中心, 北京 100034;
2. 北京大学第一医院呼吸内科, 北京 100034

收稿日期:2012-02-16 出版日期:2012-08-28 发布日期:2012-08-28
通讯作者: 李若瑜,E-mail:Lrymm@medmail.com.cn E-mail:Lrymm@medmail.com.cn
作者简介:余进,女(汉族),博士,副教授.E-mail:yujin676@gmail.com
基金资助:
卫生部部属 (管)医院2010-2012年度临床学科重点项目基金 (2010-2012),艾滋病和病毒性肝炎等重大传染病防治科技重大专项资助课题 (2008ZX1004-002)

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

YU Jin¹, MU Xiang-dong², WAN Zhe¹, QUE Cheng-li², LI Ruo-yu¹

1. Department of Dermatology and Venereology, Peking University First Hospital, Research Center for Medical Mycology, Peking University, Beijing 100034, China;
2. Department of Respiratory, Peking University First Hospital, Beijing 100034, China

Received:2012-02-16 Online:2012-08-28 Published:2012-08-28

摘要/Abstract

摘要： 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。

关键词: 自身免疫性大疱病, 糖皮质激素, 肺曲霉病

Abstract: 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 autoimmune bullous diseases with invasive pulmonary aspergillosis. KOH smear and culture, antigen detection, chest CT scan and histopathologic 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 invasive pulmonary aspergillosis. The patients were cured with voriconazole treatment and other antifungal agents.Conclusion Autoimmune 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.

Key words: autoimmune bullous diseases, glucocorticoids, invasive pulmonary aspergillosis

中图分类号:

R563.19

余进, 牟向东, 万喆, 阙呈立, 李若瑜. 自身免疫性大疱病合并侵袭性肺曲霉病:3例报告[J]. 中国真菌学杂志, 2012, (4): 214-218.

YU Jin, MU Xiang-dong, WAN Zhe, QUE Cheng-li, LI Ruo-yu. Invasive pulmonary aspergillosis in autoimmune bullous diseases patients:three cases report[J]. Chinese Journal of Mycology, 2012, (4): 214-218.

参考文献

[1] De Pauw B, Walsh TJ,Donnelly JP,et al. Revised definitions of invasive fungal disease from the European organization for research and treatment of cancer/invasive fungal infections cooperative group and the national institute of allergy and infectious diseases mycoses study group (EORTC/MSG) consensus group[J].Clin Infect Dis, 2008, 46(12): 1813-1821.
[2] 李铁男. 天疱疮和大疱性类天疱疮患者口腔念珠菌感染的调查研究[J].中国真菌学杂志,2007,2(5):284-285.
[3] Agusti C, Rano A, Filella X, et al. Pulmonary infiltrates in patients receiving long-term glucocorticoid treatment-etiology, prognostic factors, and associated inflammatory response[J]. CHEST,2003,123(2):488-498.
[4] Rhen T,Cidlowski JA.Antiinflammatory action of glucocorticoids—new mechanisms for old drugs[J].N Engl J Med,2005,353(16):1711-1723.
[5] Lionakis MS,Kontoyiannis DP.Glucocorticoids and invasive fungal infections[J].Lancet,2003,362(9398):1828-1838.
[6] Ng TT,Robson GD,Denning DW.Hydrocortisone-enhanced growth of Aspergillus spp.:implications for pathogenesis[J].Microbiology,1994,140(9):2475-2479.
[7] Verweij PE, Varga J, Houbraken J, et al. Emericella quadrilineata as cause of nvasive aspergillosis[J].Emerg Infect Dis,2008,14(4):566-572.
[8] Roilides E, Lyman CA, Filioti J, et al. Amphotericin B formulations exert additive antifungal activity in combination with pulmonary alveolar macrophages and polymorphonuclear leukocytes against Aspergillus fumigatus [J]. Antimicrob Agents Chemother, 2002, 46(6): 1974-1976.
[9] Helmick RA, Fletcher AE, Gardner AM, et al. Imidazole antibiotics inhibit the nitric oxide dioxygenase function of microbial flavohemoglobin[J]. Antimicrob Agents Chemother, 2005,49(5): 1837-1843.
[10] Chiller T, Farrokhshad K, Brummer E, et al. The interaction of human monocytes, monocyte-derived macrophages, and polymorphonuclear neutrophils with caspofungin (MK-0991), an echinocandin, for antifungal activity against Aspergillus fumigatus [J]. Diagn Microbiol Infect Dis, 2001, 39(2): 99-103.