新型隱球菌是特發(fā)性阻塞性細(xì)支氣管炎伴機(jī)化性肺炎病因

1、CASE REPORTCASE REPORTimmunocompetent individuals： Blood-RT:WBC8,700/mm3,85% segmented neutrophilselectrolytes:normalLEF:normalCRP:147 mg/LBlood culturs：negativebronchoalveolar lavage(the Gram stain,acid fastbacilli ,fungal stains,viral,bacterial,mycobacterial,fungal cultures ) ：negativeHIV serologi

2、c test:negativePPD:negativeLegionella urinary antigen test: negativean open lung biopsy: fibroblastic plugs involving bronchioles and surrounded by chronic inflammatory cells,indicate BOOP, Additionally, there were multinucleated giantcells and occasional small, non-caseating granulomasPAS: GSM:seru

3、m cryptococcal antigen test :negativeimageimageoral steroidsfluconazole ,400mg/d, 3-month course remained asymptomatic had no pulmonary infiltrates on chest radiograph. 9 months of follow-up Discussion1976200142 cases immunocompetent adults 37 (88%)Pulmonary involvement; 36 ofthe 37Isolated pulmonar

4、ymiddle agedrespiratory/constitutional symptomsgood outcomes101 casesimmunocompromised adults 1、observation alone without specific therapy2、 treatment of symptomatic patients, particularly those with extensive disease on chest radiographs3、high titers of serum cryptococcal antigen are believed to be

5、 amarker of systemic cryptococcal disease4、antifungal therapy can probably be postponed with close observation for 23 months5、oral fluconazole is an alternative6、BOOP：an inflammatory/fibrosing process involving the small airways that often results in progressive, irreversible obstructive pulmonary d

6、isease7、pathogenesis：damage of the bronchiolar epithelial cells and recruitment of T lymphocytes and neutrophils to the site of injury; many cytokines and chemokines are secreted, perpetuating the inflammatory response and leading to fibroblast formation with obliteration of the airways5 case report

7、s of an association between Cryptococcus and BOOPwe report on a case of an immunocompetent young adult without history of previous lung disease who presented with a prolonged course of significant lung involvement and BOOP. CN should be kept in mind as a possible etiology in patients who present with severe pneumonitis or bronchiolitis, even if they do not have AIDS or other immunosuppre