胸部CT显示免疫抑制患者真菌感染的早期发现:怀疑是最好的标志!

G. Durhan, Y. Baytar, Orhan Macit Ariyurek
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摘要

6岁男性急性淋巴细胞白血病患者在诱导化疗12天后出现中性粒细胞减少热。临床检查、胸片及常规培养均未发现感染病灶,开始进行抗菌药物治疗。由于持续发热,对胸部进行CT检查,发现右肺上叶有一个直径2mm的结节(图1和图2)。在之前的CT检查中未见病变,我们考虑可能是感染灶。一周后复查CT,结节大小迅速增大,直径达13mm(图3)。鉴别诊断考虑真菌感染,尤其是血管侵袭性曲霉病。支气管肺泡灌洗液半乳甘露聚糖指数2.0进一步支持影像学诊断。经抗真菌治疗,包括两性霉素B脂体治疗,感染病灶消退(图4)。患者发热、中性粒细胞减少消退出院。胸片的发现很少是特定的检测一种特定的病原体
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Early Detection of Fungal Infection in an Immunosuppressed Patient Demonstrated by Thorax CT: Suspicion is the Best Marker!
6-year-old man with acute lymphoblastic leukemia developed neutropenic fever 12 days after induction chemotherapy. The focus of infection could not be found by clinical examination, chest radiography and routine cultures and em-piric antimicrobial treatment was started. As the fever persisted, computerized tomography (CT) of the thorax was performed, and a nodule with a diameter of 2 mm in the upper lobe of the right lung was detected (Fig 1 & 2). Absence of the lesion in the previous CT led us to think about a possible focus of infection. A follow-up CT taken one week later revealed that the size of nodule increased rapidly and reached a diameter of 13 mm (Fig 3). Fungal infection, especially angioinvasive aspergillosis, was considered in the differential diagnosis. A galactomannan index level of 2.0 in the bronchoalveolar lavage fluid further supported the radiological diagnosis. After antifungal treatment, including liposomal amphotericin B, the focus of infection re-gressed (Fig 4). The patient was discharged with the regression of fever and neutropenia. The findings of chest radiographs are seldom specific for the detection of a particular pathogen in the
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