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Please use this identifier to cite or link to this item: http://hdl.handle.net/10087/5578

Title: Itraconazole単独治療で一時的に改善を認めた気管支喘息を伴わないアレルギー性気管支肺アスペルギルス症の1例
Other Titles: A CASE OF ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS THAT ITRACONAZOLE SHOWED A DEFINITE EFFECT TEMPORARILY
Authors: 磯部, 全
須賀, 達夫
濱口, 重人
原, 健一郎
青木, 望
青木, 史暁
青柳, 香菜
上野, 学
前野, 敏孝
倉林, 正彦
Keywords: allergic bronchopulmonary
aspergillosis
bronchial asthma
corticosteroid
itraconazole
Issue Date: 30-Nov-2007
Publisher: 日本アレルギー学会
Citation: アレルギー 56(11), 1390-1396 (2007)
Abstract: 58歳女性.2004年7月より湿性咳嗽が出現した.胸部単純レントゲンで右中肺野にconsolidationを認め,喀痰よりAspergillus fumigatusが培養された.itraconazole(ITCZ)が投与され改善した.2005年10月,胸部単純レントゲンで増悪が認められたため,当院へ紹介受診となった.胸部CTで両肺に結節影,左B^3bに中枢性気管支拡張像を認めた.気管支鏡検査では左B^8に粘液栓を認めた.右B^3の気管支洗浄液からAspergillus nigerが培養された.以上よりアレルギー性気管支肺アスペルギルス症(ABPA)と診断した.ITCZ単独治療を行ったところ,臨床症状は改善し,末梢血好酸球数,総IgEは低下,両肺の結節影は消失した.しかし,胸部CTで新たなconsolidationが出現したため,fulticasone propionate吸入を追加し,画像所見の改善をみた.ABPAではアレルギー・炎症,感染症の両面からの治療が重要と考えられた. A 58-year-old woman had a productive cough but not from bronchial asthma. A chest radiograph revealed infiltrative shadows in right middlelung field on September, 2004. Aspergillus fumigatus was detected in a sputum culture. She was treated with oral itraconazole. After the treatment, infiltrative shadows on her chest radiograph disappeared. On October 2005, her peripheral blood showed eosinophilla, a high serum level of total immunoglobulin E (IgE), and a chest radiograph revealed new infiltrative shadows in both lung fields. A chest computed tomography revealed multiple nodular shadows and central bronchiectasis. We detected a mucoid plug which showed a large number of eosinophils pathologically by bronchoscopy. Aspergillus niger was detected in a bronchial lavage fluid. We therefore made a diagnosis of allergic bronchopulmonary aspergillosis (ABPA). The decreases of peripheral blood eosinophils and a serum IgE level were recognized and multiple nodular shadows disappeared by reinstitution of itraconazole. However, a chest computed tomography revealed new infiltrative shadows. Therefore, we treated her with the concomitant administration of oral itraconazole and inhaled corticosteroid. All laboratory data and image findings were improved. It is critical to consider the both aspects of allergy and infection in the treatment for ABPA.
URI: http://hdl.handle.net/10087/5578
ISSN: 00214884
Appears in Collections:学術雑誌論文

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