PDF(Pubmed)
Abstract：
BACKGROUND: Invasive Aspergillosis is a fungal infection caused by Aspergillus species, typically posing life-threatening risks to immunocompromised individuals. While occurrences in immunocompetent hosts are rare, a recent case report documented fulminant pulmonary aspergillosis in an immunocompetent patient during autopsy. Here, we present a case of invasive aspergillosis in an immunocompetent woman, manifesting with disseminated lesions.
METHODS: A 29-year-old Asian woman presented to our hospital in March 2022, reporting chest pain and shortness of breath persisting for two months. Upon examination, she appeared thin and unwell, with no notable abnormalities otherwise. Radiographic imaging revealed an ill-defined lesion in her left lung. Subsequent bronchoscopy and lavage were performed, followed by initiation of empirical antibiotic therapy. Lavage results were negative for gram staining, culture, and ZN staining for AFB, but revealed numerous septate hyphae on fungal smear. Histopathological examination indicated chronic granulomatous inflammation with septal fungal hyphae, indicative of aspergillosis. Subsequent culture confirmed Aspergillus species, prompting initiation of voriconazole therapy. Remarkably, the patient exhibited significant improvement, with weight gain and restored appetite observed within a short period. Within 2 months of treatment, her symptoms resolved, and she resumed near-normal daily activities.
CONCLUSIONS: This case highlights the diagnosis of aspergillosis in an immunocompetent individual presenting with disseminated nodular lesions across the lungs, mediastinum, and abdomen. Clinicians should maintain a high index of suspicion for aspergillosis in cases of non-resolving pneumonia and disseminated nodular lesions, even in patients lacking traditional predisposing factors.
METHODS: A 29-year-old Asian woman presented to our hospital in March 2022, reporting chest pain and shortness of breath persisting for two months. Upon examination, she appeared thin and unwell, with no notable abnormalities otherwise. Radiographic imaging revealed an ill-defined lesion in her left lung. Subsequent bronchoscopy and lavage were performed, followed by initiation of empirical antibiotic therapy. Lavage results were negative for gram staining, culture, and ZN staining for AFB, but revealed numerous septate hyphae on fungal smear. Histopathological examination indicated chronic granulomatous inflammation with septal fungal hyphae, indicative of aspergillosis. Subsequent culture confirmed Aspergillus species, prompting initiation of voriconazole therapy. Remarkably, the patient exhibited significant improvement, with weight gain and restored appetite observed within a short period. Within 2 months of treatment, her symptoms resolved, and she resumed near-normal daily activities.
CONCLUSIONS: This case highlights the diagnosis of aspergillosis in an immunocompetent individual presenting with disseminated nodular lesions across the lungs, mediastinum, and abdomen. Clinicians should maintain a high index of suspicion for aspergillosis in cases of non-resolving pneumonia and disseminated nodular lesions, even in patients lacking traditional predisposing factors.
摘要：
背景：侵袭性曲霉病是由曲霉属引起的真菌感染，通常对免疫功能低下的个体构成危及生命的风险。虽然在有免疫能力的宿主中很少发生，最近的病例报告记录了尸检期间一名免疫功能正常的患者的暴发性肺曲霉病。这里,我们介绍了一个有免疫能力的女性的侵袭性曲霉病，表现为播散性病变。
方法：2022年3月，一位29岁的亚裔女性到我院就诊，报告胸痛和呼吸急促持续两个月。经检查,她看起来又瘦又不舒服，否则没有明显的异常。X线影像学检查显示她的左肺病变不明确。随后进行支气管镜检查和灌洗，随后开始经验性抗生素治疗。灌洗结果为革兰氏染色阴性，文化,和ABB的ZN染色，但在真菌涂片上发现了许多纵隔菌丝。组织病理学检查提示慢性肉芽肿性炎症伴间隔真菌菌丝，表明曲霉病。随后培养证实了曲霉属物种，提示开始伏立康唑治疗。值得注意的是,患者表现出显著的改善，在短时间内观察到体重增加和食欲恢复。治疗2个月内,她的症状消失了,她恢复正常的日常活动.
结论：该病例强调了在表现为肺部播散性结节性病变的免疫功能正常个体中对曲霉病的诊断，纵隔,和腹部。临床医生应保持高度怀疑曲霉菌病的指标,如有未解决的肺炎和播散性结节性病变,即使是缺乏传统诱发因素的患者。
方法：2022年3月，一位29岁的亚裔女性到我院就诊，报告胸痛和呼吸急促持续两个月。经检查,她看起来又瘦又不舒服，否则没有明显的异常。X线影像学检查显示她的左肺病变不明确。随后进行支气管镜检查和灌洗，随后开始经验性抗生素治疗。灌洗结果为革兰氏染色阴性，文化,和ABB的ZN染色，但在真菌涂片上发现了许多纵隔菌丝。组织病理学检查提示慢性肉芽肿性炎症伴间隔真菌菌丝，表明曲霉病。随后培养证实了曲霉属物种，提示开始伏立康唑治疗。值得注意的是,患者表现出显著的改善，在短时间内观察到体重增加和食欲恢复。治疗2个月内,她的症状消失了,她恢复正常的日常活动.
结论：该病例强调了在表现为肺部播散性结节性病变的免疫功能正常个体中对曲霉病的诊断，纵隔,和腹部。临床医生应保持高度怀疑曲霉菌病的指标,如有未解决的肺炎和播散性结节性病变,即使是缺乏传统诱发因素的患者。
