Misdiagnosed as pulmonary fungal infection in 1 case of lung cancer
[Keywords:] pulmonary fungal infection, patch video, fiberoptic bronchoscopy, brush smear
In recent years, the broad-spectrum antibiotics,
corticosteroids, cytotoxic drugs and the widespread use of immunosuppressive agents, pulmonary fungal infections a growing trend, X-ray manifestations of bronchial pneumonia, lobar pneumonia, diffuse small nodules, and even mass of the shadows and empty, from imaging and clinical performance can
easily be misdiagnosed as lung cancer or tuberculosis, fiberoptic bronchoscopy brush smear it on the early diagnosis plays a crucial role.
1 Clinical data
1.1 The case selection of patients, male, 72 years old. Diagnosis <<pulmonary fungal infection in the diagnostic criteria>>, history of physical health, no abscess, tuberculosis, lung cancer, nodules history.
1.2 Clinical manifestations of respiratory infections in patients with significant medical history, course of treatment
when there are more than 40 days, fever and cough, body temperature of 37.2 ~ 38 ??, slightly small amount of white sputum, no hemoptysis, no fatigue, night sweats and chest pain.
1.3 The auxiliary examination RBC 4.45 ?? 109 / L, Hb 142g / L, WBC 9.0 ?? 109 / L, neutral 0.819, ESR 78mm / h, normal routine urine and faeces, blood lipids, blood glucose, liver and kidney function was normal, 24h sputum concentration Charles M. tuberculosis (-, chest X-ray showed: right upper
lobe patchy inflammation. CT shows: the limitations of right upper apical posterior segment piece floc density increased shadow, edge blur, local pleural thickening.
1.4 Treatment and prognosis based on the above
characteristics, consider the following possibilities: (1 lung
inflammation: the history of patients with moderate degree of fever, chest radiograph with shadow, without a lot of purulent history slightly, according to treatment for pneumonia with ceftriaxone 2g / d, total 14 days, the lesion had no significant absorption, so a small possibility of pneumonia, drug withdrawal, (2 TB: After the section of the right lung apex is the predilection sites of tuberculosis, PPD test was (+, ESR fast to support tuberculosis, but the patients with no TB symptoms , 24h check TB sputum (-, experimental anti-TB
treatment, given isoniazid 300mg, rifampicin 450mg, day 1 orally, streptomycin 750mg, day 1 intramuscularly, pyrazinamide 500mg, each 3 times a day orally.
antituberculosis drug therapy by the 18 days ESR 70mm / h down to 20mm/h.CT review said: right upper apical posterior segment lesions compared with the previous expansion. stop anti-TB
treatment, lung cancer may be considered, (3 lung cancer: old male, medium heat, slow onset, CT found that massive shadow of right upper lobe group, clinical symptoms are not typical, requiring further confirm the diagnosis. by the higher hospital after the biopsy and bronchoscopy brush smear, the final diagnosis: lung fungal infection. fluconazole therapy were followed up for six months without recurrence.
Discussion of 2 cases
Case characteristics can be considered under this diagnosis: (1 lung inflammation, (2 TB, (3 lung cancer, (4 pulmonary fungal infections. Auxiliary examination preferred chest X-
ray, CT examination, sputum culture, blood, urine, ESR, if the
examination can not be clearly diagnosed cases, to consider bronchoscopy and brush biopsy smears, clinical practice has proved: this check can not only further confirm the diagnosis, but also play a crucial role in clinical treatment,
particularly is to avoid the abuse of antibiotics.
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