SUBAKUT NEKROTİZAN PULMONER ASPERGİLLOZİS: OLGU SUNUMU

Yıl 2004, Cilt: 18 Sayı: 2, 83 - 88, 01.10.2004

Sezen Şenirmak Özden Gürkan Ertuğrul Şevket Dereli Can Binçmen Rifat Özacar

Öz

Kronik nekrotizan pulmoner aspergillozis genellikle var olan akciğer hastalığı veya immun sistem bozukluğu nedeniyle meydana gelen lokal savunma bozukluğu olan hastalarda görülen subakut bir enfeksiyondur. Altmış bir yaşında KOAH tanısı olan erkek hasta siyanoz, ilerleyici dispne ve balgam çıkarma yakınması ile başvurdu. İki hafta süreli geniş spektrumlu antibiotik, bronkodilatatör ve steroid tedaviye rağmen semptomları ilerledi. Göğüs radyografisi ve BT'de sol alt lob superior segmentte infiltrasyon görüldü. 1 ay içinde klinik durumu bozuldu ve aynı dönemde çekilen BT'de sol alt lobda miçetoma içeren kavite ve plevral efüzyon görüld ü. Bronşial lavaj ve balgam kültüründe Aspergillus sp. üredi ve malignite saptanmadı. Başlanan Amfoterisin B lipid kompleks tedavisi ile tedaviden 1 ay sonra klinik ve radyolojik bulgularda düzelme saptandı. Tedaviye İtrakonazol ile devam edildi, başlangıç semptomları geriledi ve radyografik düzelme devam etti. Olgumuzu erken tanınıp tedavi edilmiş olması ve tedavinin başarılı olması nedeniyle literatür eşliğinde sunduk.

Anahtar Kelimeler

Aspergillozis, akut, nekrotizan

SUBACUTE NECROTIZING PULMONARY ASPERGILLOSIS: CASE REPORT

Öz

Chronic necrotizing pulmonary aspergillozis is a subacute infection most commonly seen in patients with altered local defense due to preexisting pulmonary disease or in patients with risk factors that alter systemic immune status. A sixtyone-year-old male patient diagnosed with COPD presented cyanosis, worsening dyspnea and sputum production. Despite two weeks of broad-spectrum antibiotic, bronchodilatator and steroid therapy, his symptoms progressed. His chest radiograph and CT scan revealed an infiltration at superior segment of left lower lobe (LLL). In 1 month, his clinical condition deteriorated and subsequent CT scan showed cavitiy in LLL with mycetoma and pleural effusion. Aspergillus sp. grew in bronchial washing and sputum cultures and cytology revealed no malignancy. After 1 months of treatment with amphoterisin B lipid complex (ABLC), clinic and radiographic findings improved significantly. Therapy continued with itraconazole, during 3 months and his initial symptoms resolved and radiographic improvement is continued. We report this case as he was early diagnosed and treated successfully by reviewing the literature.

Anahtar Kelimeler

Aspergillosis, acute, necrotizing

Kaynakça

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