肝移植前に内視鏡下鼻内手術を行い上顎洞内よりスエヒロタケが検出された症例

Schizophyllum commune detected in the maxillary sinus by endoscopic sinus surgery before liver transplantation

はじめに

　スエヒロタケは，朽ち木などで頻繁にみられるキノコ（真正担子菌）の一種である。キノコは真菌に分類されるが，ヒトに感染・定着するものは稀とされる^1）。近年，スエヒロタケによるアレルギー性真菌性鼻副鼻腔炎やアレルギー性気管支肺真菌症についての報告が散見される^2,3）。今回われわれは，肝移植前に副鼻腔炎に対し手術を行い，上顎洞内の菌塊よりスエヒロタケが検出された症例を経験したので，文献的考察を加えて報告する。

　Recently, cases of allergic fungal rhinosinusitis and allergic bronchopulmonary mycosis caused by Schizophyllum commune havebeen reported. We encountered a case in which Schizophyllum commune was detected in a maxillary sinus mass before liver transplantation.

　A 52-year-old woman was found to have sinus lesions on pre-liver transplant examination. CT and MRI imaging revealed lesions in the left maxillary and sphenoid sinuses. In addition, Chest CT revealed transient atelectasis in the lower right lobe, probably due to a mucous plug. Endoscopic sinus surgery was performed to prevent exacerbation of the sinus lesions due to immunosuppression. The grayish-white deposits found in the maxillary sinus were diagnosed as Schizophyllum commune. Endoscopic sinus surgery should be performed because the presence of Schizophyllum commune may affect the course of the transplant surgery.