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題名 | Disseminated Cryptococcosis in a HIV-Negative Patient Initially Presenting as Bilaterally Massive Pleural Effusion: A Case Report & Literature Review=一位非愛滋病毒感染之病患得到瀰漫性新型隱球菌感染初期以雙側大量肋膜積液表現之病例報告及文獻回顧 |
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作者 | 陳美音; 陶啟偉; Chen, Mei-yin; Tao, Chi-wei; |
期刊 | 胸腔醫學 |
出版日期 | 20130600 |
卷期 | 28:3 2013.06[民102.06] |
頁次 | 頁186-191 |
分類號 | 415.46 |
語文 | eng |
關鍵詞 | 瀰漫性新型隱球菌感染; 雙側大量肋膜積液; Disseminated cryptococcosis; Bilaterally massive pleural effusion; |
中文摘要 | 新型隱球菌是一種感染人類的黴菌致病菌。通常會對免疫功能不全之病人,有時也對免疫功能正常之病人產生造成生命威脅之感染。感染途徑通常經由吸入土壤氣霧。瀰漫性感染通常發生於免疫力不全之病人,尤其是有惡性腫瘤,愛滋病毒感染,使用類固醇,或器官移植後之病人,但極少見於免疫力正常之病人。常見之胸部X光表現為局部浸潤或肺結節。電腦斷層亦呈現一或多個開洞或未開洞之周邊結節或實質病變。我們在此呈現之病例為一72歲台灣女性,無愛滋病,有輕微糖尿病但經由飲食控制良好,主訴咳嗽及呼吸困難。胸部X光呈現雙側肋膜積水。後來診斷為瀰漫性新型隱球菌感染,包括肋膜積水,腦膜炎,心包膜積水,感染性心內膜炎,腹膜炎,及新型隱球菌造成的菌血症。即使給予適當治療,病人仍然產生多重器官衰竭,最後死亡。 |
英文摘要 | Cryptococcus neoformans is a human fungal pathogen that causes life-threatening infection in immunocompromised hosts, and in some cases, immunocompetent hosts. Inoculation is usually via the inhalation of soil aerosols. Disseminated disease is the most common presentation among immunocompromised persons with malignancy, human immunodeficiency virus infection, corticosteroid use, or organ transplantation, but is rare in immunocompetent hosts. The most common plain radiographic findings are focal infiltrates and pulmonary nodules. Chest computed tomography similarly reveals one or more peripheral nodules with or without cavitation and/or areas of consolidation. We present the case of a 72-year-old, HIV-negative Taiwanese woman with mild type 2 diabetes mellitus under good dietary control who presented with cough and dyspnea. Initial chest plain film showed bilaterally massive pleural effusion. Disseminated cryptococcosis with pleural effusion, meningitis, pericardial effusion, infective endocarditis, peritonitis, and cryptococemia was diagnosed, and despite adequate antifungal treatment the patient developed multiple organ failure and eventually expired. |
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