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題 名 | Melioidosis with Lung Mass and Mediastinal Lymphadenitis: A Case Report=類鼻疽合併肺部腫瘤及縱膈腔淋巴結炎:病例報告 |
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作 者 | 陳君禮; 許正園; 覃俊士; | 書刊名 | 胸腔醫學 |
卷 期 | 29:1 2014.02[民103.02] |
頁 次 | 頁46-51 |
分類號 | 415.15 |
關鍵詞 | 類鼻疽; 類鼻疽伯克氏菌; 縱膈腔淋巴結病變; Burkholderia pseudomallei; Melioidosis; Mediastinal lymphadenopathy; |
語 文 | 英文(English) |
中文摘要 | 類鼻疽(melioidosis)是由類鼻疽伯克氏菌(Burkholderia pseudomallei)所造成的疾病,且多盛行於澳洲北部及泰國東北部。台灣南部在2005 年的雨季時曾出現群聚感染的病患。肺部是最常被感染的器官。急性肺部感染多以肺炎表現。亞急性和慢性感染則有多樣的肺部變化,像是肺膿瘍、肺開洞、肺塌陷以及鈣化結節。縱膈腔淋巴結病變是極少見的肺部變化。因此,慢性肺部感染在影像學上可能會和肺結核或是肺癌混淆。在此,我們報告一位67歲有糖尿病史的男性,表現為咳嗽有痰和體重減輕。影像學上發現右側肺門的肺部腫瘤合併縱膈腔淋巴結病變,經檢查無惡性細胞或是肺結核的可能。病人於兩個月後因發燒再次入院,血液培養發現感染類鼻疽伯克氏菌,經使用靜脈注射抗生素ceftazidime兩週及imipenem/cilastatin兩週,病人1個月後,在臨床症狀及胸部X光改善下出院。出院後繼續使用6個月的口服抗生素tetracycline。 |
英文摘要 | Melioidosis, caused by Burkholderia pseudomallei, is highly endemic to northern Australia and northeast Thailand. An outbreak of melioidosis was identified in southern Taiwan after a rainy season in 2005. The lung is the most commonly affected organ. Acute pulmonary melioidosis is commonly presented with pneumonia. Subacute or chronic infection has diverse lung manifestations, such as abscess, cavitation, and calcified node. Lung mass and mediastinal lymphadenopathy are rarely seen. The radiographic pattern of chronic pulmonary melioidosis can mimic pulmonary tuberculosis or lung cancer.Herein, we report a 67-year-old man with a history of diabetes mellitus who presented with productive cough and loss of body weight. The radiographic finding was a mass at the right hilum with mediastinal lymphadenopathy. A detailed survey revealed no malignancy or pulmonary tuberculosis. The patient was admitted for fever 2 months later. Blood cultures yielded Burkholderia pseudomallei. Antibiotics with intravenous ceftazidime for 2 weeks and imipenem/cilastatin for 2 weeks were prescribed. He was discharged 1 month later with good improvement of clinical symptoms and chest x-ray findings. Oral tetracycline was continued for 6 months. |
本系統中英文摘要資訊取自各篇刊載內容。