原発性肺クリプトコッカス症の1自験例と本症本邦41例の検討

Acase of primary pulmonary cryptococcosis and review of 41 cases reported in Japan

　中枢神経との親和性が強いと考えられるクリプトコッカスは，典型的には免疫学的に異常状態にある患者に，髄膜炎をおこすことが知られている^1）。しかし最近，何の異常を示さない正常人に，侵入門戸である肺^2）にのみクリプトコッカスが病変をつくり，呼吸器症状等のあまり認められない，いわゆる原発性肺クリプトコッカス症があり，かつ比較的多いものと考えられてきた。われわれは今回，原発性肺クリプトコッカス症の1例を経験したので，現在まで報告のあった本邦41例についての考察とあわせて報告する。

A 29 year-old male laboratory technician was admitted to Tokai University Hospital because of 3 days history of dry cough and backache. Physical examination revealed no abnormality except a few rhonchi heard at the left lung base. A chest X-ray film showed a dense nodular shadow localized in the left lower lobe. Although the laboratory data showed no significance and failed to clarify the etiology during the hospitalization, his symptoms got worse. A trans-bronchial lung biopsy (TBLB) performed on the 5th hospital day helped us to diagnose primary pulmonary cryptococcosis (PPC). Following the treatment with 5FC for 4 months, his symptoms subsidedwith the almost complete dissapearance of the abnormal lung shadow. Of41 cases of PPC reported in Japan, only 2 cases were female, and the onset of 33 cases wasbetween the second and forth decade. With only two exception, single lobe was involved and a high predilection for the lower lobe was also noted. In 66% of the cases, the disease was de-tected at the annual health check-up incidentaly without any symptoms. Only a few cases com-plained of chest pain, cough, sputum, hemoptysis, fever and/or easy fatigability. The routine laboratory data showed no abnormality in the most cases. In 31% of the cases cryptococci were found positive in sputa, and in 71% the diagnosis was made based on the open lung biopsy. Only 3 of 38 cases were diagnosed by TBLB, in which diagnostic procedures were described. We con-sider that PPC is a disease of the man predomi-nantly and develops between the second and forth decade, and that the TBLB is quite useful for making diagnosis.