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

doi:10.3969/j.issn.1000-6621.2018.11.016

摘要/Abstract

摘要：

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。

关键词: 隐球菌病, 肺疾病, 真菌性, 结核, 淋巴结, 纵隔, 误诊, 结果与过程评价(卫生保健)

Abstract:

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.

Key words: Cryptococcosis, Lung diseases, fungal, Tuberculosis, lymph node, Mediastinum, Diagnostic errors, Outcome and process assessment (health care)

朱桂云,李晓霞,康丽菲,陈宁,杨永辉. 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[J]. 中国防痨杂志, 2018, 40(11): 1231-1234. doi: 10.3969/j.issn.1000-6621.2018.11.016

ZHU Gui-yun,LI Xiao-xia,KANG Li-fei,CHEN Ning,YANG Yong-hui. A case of pulmonary cryptococcosis with mediastinal tuberculous lymphadenitis——report of case and review of literature[J]. Chinese Journal of Antituberculosis, 2018, 40(11): 1231-1234. doi: 10.3969/j.issn.1000-6621.2018.11.016

图/表 2

参考文献 22

[1]	《中国真菌学杂志》编辑委员会. 隐球菌感染诊治专家共识. 中国真菌学杂志, 2010,5(2):65-68,86. doi: 10.3969/j.issn.1673-3827.2010.02.001 URL
[2]	Esher SK, Zaragoza O, Alspaugh JA . Cryptococcal pathogenic mechanisms: a dangerous trip from the environment to the brain. Mem Inst Oswaldo Cruz, 2018,113(7):e180057. doi: 10.1590/0074-02760180057 URL pmid: 29668825
[3]	Brown GD, Denning DW, Gow NA , et al. Hidden killers: human fungal infections. Sci Transl Med, 2012, 4(165): 165rv13.
[4]	Ye F, Xie JX, Zeng QS , et al. Retrospective analysis of 76 immunocompetent patients with primary pulmonary cryptococcosis. Lung, 2012,190(3):339-346. doi: 10.1007/s00408-011-9362-8 URL pmid: 22246551
[5]	Jain S, Mahajan V, Kumar A . Unusual case of coexistent pulmonary cryptococcosis and tuberculosis in an immuno-competent host. Indian J Tuberc, 2017,64(3):228-231. doi: 10.1016/j.ijtb.2016.09.016 URL pmid: 28709495
[6]	Rajasingham R, Smith RM, Park BJ , et al. Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis. Lancet Infect Dis, 2017,17(8):873-881. doi: 10.1016/S1473-3099(17)30243-8 URL pmid: 28483415
[7]	Deng H, Zhang J, Li J , et al. Clinical features and radiological characteristics of pulmonary cryptococcosis. J Int Med Res, 2018,46(7):2687-2695. doi: 10.1177/0300060518769541 URL pmid: 29848126
[8]	彭雅婷, 欧阳若芸, 蒋谊 . 28例原发性肺隐球菌病临床特征分析. 中南大学学报(医学版), 2014,39(1):49-55. doi: 10.11817/j.issn.1672-7347.2014.01.009
[9]	梁丽玲, 梁志欣, 陈良安 . 肺隐球菌病临床诊治进展. 中华医院感染学杂志, 2017,27(6):1437-1440. doi: 10.11816/cn.ni.2016-170299 URL
[10]	Chang CC, Sorrell TC, Chen SC . Pulmonary cryptococcosis. Semin Respir Crit Care Med, 2015,36(5):681-691. doi: 10.1055/s-00000075 URL
[11]	顾烟直, 黄绍萍, 卢水华 . 肺隐球菌病的诊治进展. 中国全科医学, 2009,12(18):1746-1748. doi: 10.3969/j.issn.1007-9572.2009.18.038 URL
[12]	吴俊 . 肺隐球菌病(PC)肺部CT增强扫描影像表现及临床病理分析. 中国CT和MRI杂志, 2016,14(1):59-61. doi: 10.3969/j.issn.1672-5131.2016.01.019 URL
[13]	吴重重, 赵绍宏, 聂永康 , 等. 免疫正常与抑制患者原发性肺隐球菌病的CT征象分析. 结核病与肺部健康杂志, 2015,4(3):162-168. doi: 10.3969/j.issn.2095-3755.2015.03.004
[14]	杨澄清, 杜荣辉, 曹探赜 , 等. 首诊误诊为肺结核的肺隐球菌病26例临床分析. 中国防痨杂志, 2017,39(12):1297-1302.
[15]	赵泽钢, 周新华, 吕岩 , 等. 表现为孤立结节的原发性肺隐球菌病CT诊断及鉴别. 中国防痨杂志, 2016,38(5):358-363. doi: 10.3969/j.issn.1000-6621.2016.05.007 URL
[16]	李维华, 纪小龙 . 呼吸系统病理学.北京: 人民军医出版社, 2011: 108-110.
[17]	何福果 . 肺隐球菌病临床病理分析. 检验医学与临床, 2013,10(22):2964-2965,2967.
[18]	王艳玲, 阳昱恒, 于农 , 等. 未见明显免疫功能低下的11例肺隐球菌病临床特征分析并文献复习. 中国真菌学志, 2018,13(3):148-151,163.
[19]	施裕新, 张志勇, 王月波 . 免疫缺陷性肺结核的临床研究进展. 中国防痨杂志, 2012,34(4):248-251.
[20]	杨贤明, 陈伟生, 翁加豪 , 等. CT引导下经支气管镜针吸活检术诊断纵隔和肺门周围肿块的效果分析. 结核病与肺部健康杂志, 2015,4(2):109-112. doi: 10.3969/j.issn.2095-3755.2015.02.008 URL
[21]	周颖杰, 李光辉 . 隐球菌病处理临床实践指南: 2010年美国感染病学会更新. 中国感染与化疗杂志, 2010,10(3):161-166.
[22]	卢水华, 席秀红, 熊延青 , 等. 肺结核合并肺隐球菌病8例分析. 中国防痨杂志, 2009,31(9):553-554.