感染巣切除後に再燃予防に抗真菌薬を投与した肺クリプトコッカス症の1例

Pulmonary Cryptococcosis Treated with Antifungal Drugs After Surgical Resection：Report of a Case

はじめに　肺クリプトコッカス症に対する治療では通常，抗真菌薬による治療が行われるが，画像上では悪性腫瘍との鑑別が困難で，診断と治療を兼ねて外科的切除することも少なくない1）．病巣を完全切除した後の抗真菌薬投与の要否においては科学的根拠がなく，ガイドライン上も明記されていない．われわれは手術と術後の抗真菌薬投与を行い，その後無再燃の1例を経験したため報告する．

The patient is an 81-year-old man. He underwent surgery for pancreatic body cancer in 201X and was followed up every six months with computed tomography （CT） imaging. A CT scan in 201X＋5 showed a new nodule in S6 of the right lung. The nodule grew in the latter half of the year and was diagnostically resected on suspicion of being a metastatic lung tumor. A histopathological examination of the resected lung revealed pulmonary cryptococcosis. The postoperative course was uneventful, and the patient was treated with fluconazole 200 mg/day for six months. The patient is currently alive and recurrence-free three years after surgery. Pulmonary cryptococcosis can recur and may be complicated by meningitis. Postoperative antifungal therapy should be considered because of the poor prognosis of meningitis. Postoperative treatment should be performed with caution, especially in patients who are susceptible to infection, have positive preoperative serum cryptococcal antigen levels or have a high standardized uptake value （SUV） max on positron emission tomography （PET）-CT scanning, and are considered to have high fungal loads or activity.