Amphotericin Bの吸入療法が有効であったアレルギー性気管支肺カンジダ症の1例  [in Japanese] A Case of Allergic Bronchopulmonary Candidiasis Treated with Amphotericin B Inhalation.  [in Japanese]

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症例は77歳男性. 夜間の喘息発作のため当院某内科に入院した. ステロイドを含む治療により一旦は軽快したが, 胸部X線上の両側性かつ移動性の浸潤陰影が出現し, 各種抗生剤の投与によっても改善がみられず, 難治性肺炎の診断にて当科に転科となった. 喀痰より多量の <i>C. albicans</i> が検出され, 本真菌に対する特異的IgE抗体ならびに沈降抗体がともに陽性であり, <i>C. albicans</i> 抗原の百万倍希釈液にても即時型皮内反応が陽性であった. さらにBALF中にも <i>C. albicans</i> が検出されたことなどからアレルギー性気管支肺カンジダ症 (allergic bronchopulmonary candidiasis) と診断した. Amphotericin B の吸入療法により, 肺浸潤陰影ならびに臨床症状の著明な改善が観察された. 本症についての症例報告は本邦では少数であり, また amphotericin B の吸入療法により症状の寛解が得られた点から興味深い症例と考えられた.

A 77-year-old man underwent emergency admission for nocturnal asthmatic attack. Although his asthmatic attack improved within a few days with treatment including systemic corticosteroid, bilateral recurrent infiltrative shadows developed in his chest roentgenogram in association with a further exacerbation of dyspnea. Various antibiotic agents were given; however, the pulmonary infiltration did not improve. He was transfered to our department with the diagnosis of intractable pneumonia. <i>C. albicans</i> was detected in the sputum, and both IgE antibody and precipitating antibody specific for <i>C. albicans</i> were positive. Immediate cutaneous reactivity to <i>C. albicans</i> was positive even with a million-fold dilution of antigen extract. <i>C. albicans</i> was also detected in bronchoalveolar lavage fluid. A diagnosis of allergic bronchopulmonary candidiasis was made. Chest roentgenographic findings as well as clinical symptoms improved with inhalation of 50mg of amphotericin B.


  • The Japanese journal of thoracic diseases

    The Japanese journal of thoracic diseases 30(2), 352-357, 1992

    The Japanese Respiratory Society


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