胸腔病例（三五三）肺白黴菌病

10.6666/ClinMed.201810_82(4).0114

羅柏鈞；林芳綺

伺機性黴菌疾病(opportunistic mycoses) ； 肺白黴菌病(pulmonary mucormycosis) ； amphotericin B

臨床醫學月刊

82卷4期（2018 / 10 / 26）

622 - 627

繁體中文

白黴菌病(mucormycosis)並不常見，但在免疫功能低下的病患(immunocompromise host)卻是死亡率很高的一種伺機性黴菌疾病(opportunistic mycoses)。白黴菌病兩種主要的疾病表現為鼻腔腦白黴菌病(rhinocerebral mucormycosis)以及肺白黴菌病(pulmonary mucormycosis)。前者好發於糖尿病的病人，後者常見於長時間嗜中性白血球數目低下的血液腫瘤（如白血病、淋巴瘤）患者。肺白黴菌病的臨床症狀並無特異性，血液培養的結果多半是陰性，痰液培養的結果即使是陽性也難以區別是移生菌(colonizer)還是致病菌，經由支氣管鏡檢查執行支氣管肺泡灌洗術或是肺部組織切片成為肺白黴菌病重要的診斷工具。本篇文章報告一位84歲男性有何杰金氏淋巴瘤的疾病史，接受化療一個禮拜之後發燒，血液常規檢查發現低嗜中性球偏低，胸部X光檢查發現雙上側肺炎，經多種廣效性抗生素治療，肺炎仍持續進展。之後患者接受支氣管肺泡灌洗術檢查，在灌洗液的細胞學檢查發現黴菌。之後痰液和及支氣管肺泡灌洗液的黴菌培養均長出假根毛黴屬(Rhizomucor spp.)。可惜患者即使接受長時間的抗黴菌藥物，liposomal amphotericin B，的治療，肺部的病灶仍持續進展，患者最後仍然宣告不治。

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