[Case of chronic necrotizing pulmonary aspergillosis successfully treated with a combination of liposomal amphotericin B and itraconazole].
[Case of chronic necrotizing pulmonary aspergillosis successfully treated with a combination of liposomal amphotericin B and itraconazole].
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脂质体两性霉素B联合伊曲康唑成功治疗慢性坏死性肺曲霉病一例
DOI：
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发表时间：
2008
期刊：
影响因子：
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通讯作者：
A. Ito
中科院分区：
文献类型：
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作者：
H. Kiyokawa;R. Nakashima;S. Takafuji;Yuka Suzuki;A. Ito
1例58岁日本男性患者入院时出现高烧、咳嗽、明显的白细胞增多症，胸部X光检查发现肺囊肿内有浸润物和液面。他因肺结核接受了6个月的治疗。他还接受了慢性阻塞性肺疾病的家庭氧疗和类风湿性关节炎的每日10毫克强的松龙治疗。从支气管冲洗液中培养出烟曲霉，诊断为慢性坏死性肺曲霉病(CNPA)。米卡芬净最初有效，但9周后症状复发。停用米卡芬净，经静脉注射两性霉素B和口服伊曲康唑胶囊联合治疗后，症状和实验室指标明显改善。15周后，他的药物被改为口服伏立康唑，他出院了。CNPA是一种预后较差的慢性感染性疾病，目前尚无标准的治疗方法。每种抗真菌药物都有不同的作用机制和作用部位。在几种药物治疗失败的情况下，实现药物相互作用的联合治疗可以成为一种治疗选择。
A 58-year-old Japanese man was admitted with high fever, productive cough, marked leukocytosis, and chest X-ray findings of infiltration and fluid levels within lung cysts. He had been treated for pulmonary tuberculosis for 6 months. He was also receiving home oxygen therapy for chronic obstructive pulmonary disease and 10 mg prednisolone daily for rheumatoid arthritis. Aspergillus fumigatus was cultured from bronchial washing fluid and we diagnosed chronic necrotizing pulmonary aspergillosis (CNPA). Micafungin was initially effective but 9 weeks later the symptoms recurred. Micafungin was stopped and after combination therapy of intravenous liposomal amphotericin B and oral itraconazole capsule was started his symptoms and laboratory data markedly improved. Fifteen weeks later his medication was switched to oral voriconazole and he was discharged. CNPA is a chronic infectious disease with poor prognostic and no standard therapy has been confirmed. Each antifungal drug has different mechanisms and sites of action. In the case of treatment failure with several drugs, combination therapy to achieve drug interaction can be a treatment option.