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題 名 | Disseminated Cryptococcosis with Acute Respiratory Distress Syndrome in a Patient with Newly Diagnosed Systemic Lupus Erythematosus--A Case Report=系統性紅斑性狼瘡的患者發生瀰散性隱球菌症合併急性呼吸窘迫症--病例報告 |
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作 者 | 林進國; 蔡熒煌; 黃崇旂; | 書刊名 | 胸腔醫學 |
卷 期 | 17:4 2002.12[民91.12] |
頁 次 | 頁425-429 |
分類號 | 415.695 |
關鍵詞 | 瀰散性隱球菌症; 急性呼吸窘迫症; 墨汁染法; 系統性紅斑性狼瘡; Disseminated cryptococcosis; Acute respiratory distress syndrome; India ink stain; Systemic lupus erythematosus; |
語 文 | 英文(English) |
中文摘要 | 後天免疫不全的病人,容易得到隱球菌的感染且可能導致急性呼吸窘迫症,並造成很高的死亡率。但是在非後天免疫不全的病人,隱球菌很少引起急性呼吸窘迫症,而且常被忽略。我們報告一位三十歲懷孕女性因全身瘀青及紫瘢而住院,之後發生急性呼吸衰竭,初步診斷為系統性紅斑性狼瘡合併瀰散性肺出血。以類固醇脈衝治療後,肺出血初步有改善,但隨後又發生急性呼吸窘迫症。用墨汁染法發現支氣管肺泡沖洗液存有隱球菌,血液及腦脊髓也都有隱球菌感染。最後診斷為瀰散性隱球菌症合併急性呼吸窘迫症。回顧過去的文獻,非後天免疫不全的病人發生瀰散性隱球菌症合併急性呼吸窘迫症相當罕見。 |
英文摘要 | Opportunistic cryptococcal infection has been noted to occur in patients with acquired immunodeficiency syndrome (AIDS), and may contribute to acute respiratory distress syndrome (ARDS) with a high mortality. But in human immunodeficiency virus (HIV) - negative patients, cryptococci rarely cause ARDS, and are often ignored in the beginning stages of the disease. We reported a 30-year-old pregnant female with diffuse pulmonary cryptococcosis. She developed acute respiratory failure due to diffuse alveolar hemorrhage from systemic lupus erythematosus (SLE). Methylprednisolone pulse therapy was given for the diffuse alveolar hemorrhage, and the chest roentgenogram showed initial improvement. Unfortunately, bilateral lung infiltrations became exacerbated again, and the patient later developed ARDS. Cryptococcal yeasts were identified promptly using India ink staining of the bronchoalveolar lavage fluid. Blood culture and cerebrospinal fluid studies also revealed cryptococcal infection. Disseminated cryptococcosis contributing to ARDS was finally diagnosed. A review of the literature showed that ARDS caused by disseminated cryptococcosis is rarely seen in HIV-negative patients. |
本系統中英文摘要資訊取自各篇刊載內容。