新型隐球菌是特发性阻塞性细支气管炎伴机化性肺炎的病因.ppt

* ＣＡＳＥ　ＲＥＰＯＲＴ CASE REPORT CN（cryptococcus neoformans） as a cause of BOOP (bronchiolitis obliterans organizing pneumonia) CN（cryptococcus neoformans） 1、immunocompromised patients： 2、immunocompetent individuals： systemic infections localized pulmonary disease BOOP (bronchiolitis obliterans organizing pneumonia ) a rare severe form of pneumonitis caused by a variety of infectious and toxic agents or connective tissue diseases 1、BOOP due to CN has very rarely been reported; 2、mostly in immunocompromised patients. We report a case： CN-associated BOOP in an immunocompetent individual and discuss the diagnosis and treatment of this entity. *a 30-year old healthy Caucasian male *10-day history of fever/chills and nonproductive cough *denied any tobacco or illicit substance use *a recent hunting trip to Canada oxygen saturation level was normal a chest radiograph showed right upper lobe consolidation. oral levofloxacin returned 3 days later with persistent fever, cough, and headache. hospitalized intravenous ceftriaxone and azithromycin A repeated chest radiograph/CT-scan: bilateral upper and lower lobe consolidations and nodularity negative PPD: negative HIV serologic test: negative bronchoalveolar lavage (the Gram stain,acid fastbacilli ,fungal stains,viral,bacterial,mycobacterial,fungal cultures ) ： negative Blood culturs： 147 mg/L CRP: normal LEF: normal electrolytes: WBC8,700/mm3,85% segmented neutrophils Blood-RT: negative serum cryptococcal antigen test : GSM: PAS: fibroblastic plugs involving bronchioles and surrounded by chronic inflammatory cells,indicate BOOP, Additionally, there were multinucleated giant cells and occasional small, non-caseating granulomas an open lung biopsy: negative Legionella urinary antigen test: image image oral steroids fluconazole ,400mg/d, 3-month course remained asymptomatic had no pulmonary infiltrates on chest radiograph. 9 months of follow-up Discussion 101 cases immunocompromised adults ●middle aged●r