支气管结石合并肺部盖尔森基兴奴卡菌感染1例

本文旨在通过对1例支气管结石伴盖尔森基兴奴卡菌肺炎患者的诊治过程进行回顾，并对相关文献进行复习，以提高临床医师对此类疾病的认识。该患者为结石性体质，胸部计算机断层扫描(computed tomography，CT)提示支气管内高密度影；无痛纤维支气管镜下确诊支气管内膜结石，给予患者支气管镜下碎石、取石，并送病理科行切片活检，同时行痰涂片、痰培养寻找病原体。结果成功在肺泡灌洗液中培养出盖尔森基兴奴卡菌，针对盖尔森基兴奴卡菌感染给予敏感药物治疗3个月后痊愈。支气管结石伴盖尔森基兴奴卡菌肺炎极其罕见，尤其局限于呼吸系统感染者更为少见。此类疾病需考虑支气管内膜结石所致支气管扩张等结构性疾病存在，导致局部抵抗力低下，从而引起条件致病菌盖尔森基兴奴卡菌感染。针对此类患者，建议及早行纤维支气管镜检查并完善灌洗液涂片、抗酸染色、灌洗液培养以获得病原学证据，为治疗赢得时间。控制盖尔森基兴奴卡菌感染后，需及早行纤维支气管镜下碎石等治疗，以纠正局部结构改变，减少再次感染机会。

One case of broncholithiasis with Nocardia cyriacigeorgica infection

The present paper aims to review the diagnosis and treatment of one case of broncholithiasis with Nocardia cyriacigeorgica infection, and the relevant literatures, and to raise the awareness of this disease. The patient was calculus body habitus. Chest computed tomography (CT) showed endobronchial high-density shadow. After broncholithiasis was confirmed by painless fiberoptic bronchoscopy, bronchoscopic lithotripsy was performed to remove the stones for pathological biopsy. At the same time, sputum smears, sputum cultures were conducted to find the pathogens. Nocardia cyriacigeorgica was successfully cultured in bronchoalveolar lavage fluid. After the administration of sensitive drugs for three months the patient was clinically recovery. Broncholithiasis with Nocardia cyriacigeorgica pneumonia is extremely rare. To treat this case the clinicians should consider that the presence of endobronchial stones may lead to structural diseases, resulting in low local immunity and causing Nocardia cyriacigeorgica infection. For such disease, it is recommended to take fiberoptic bronchoscopy, lavage fluid smear, acid-fast staining, and lavage fluid culture as soon as possible to obtain etiological evidence. After the infection is controlled, lithotripsy under bronchoscope should be performed as soon as possible to correct local structural changes and reduce the incidence of reinfection.