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.pptVIP

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 Blood-RT: WBC8,700/mm3,85% segmented neutrophils electrolytes: normal LEF: normal CRP: 147 mg/L Blood culturs ： negative bronchoalveolar lavage ( the Gram stain,acid fastbacilli ,fungal stains,viral,bacterial,mycobacterial,fung al cultures ) ： negative HIV serologic test: negative PPD: negative Legionella urinary antigen test: negative an open lung biopsy: fibroblastic plugs involving bronchioles and surrounded by chronic inflammatory cells,indicate BOOP , Additionally, there were multinucleated giant cells and occasional small, non-caseating granulomas PAS: GSM: serum cryptococcal antigen test : negative 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 1976 ↓ 2001 42 cases immun