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病例40-2018:一名患复发性鼻窦炎、咳嗽和支气管扩张的47岁女性
Case 40-2018 — A 47-Year-Old Woman with Recurrent Sinusitis, Cough, and Bronchiectasis


James E. Mojica ... 呼吸系统疾病 • 2018.12.27
相关阅读
• VX-659–tezacaftor–ivacaftor三联疗法用于携带1或2个Phe508del等位基因的囊性纤维化患者 • VX-445–tezacaftor–ivacaftor三联疗法用于携带1或2个Phe508del等位基因的囊性纤维化患者

病例陈述


Christopher J. Richards医师:一名47岁女性因复发性鼻窦炎伴进行性咳嗽和支气管扩张,在本院肺科门诊接受了评估。

这名患者从二十五六岁开始就反复发生鼻窦充血,每年有2~3次鼻窦感染,这促使其接受多个疗程的抗生素治疗。在患者大约30岁的时候,另一家医院的耳鼻喉科医师对她进行了评估,医师认为可能是过敏引发的症状。皮肤试验显示环境过敏(对灰尘、草和猫过敏)。血液检查显示对多种食物(包括奶、酵母、小麦、麸质、黑麦和蛋清)过敏。从患者饮食中去除奶类、谷物和鸡蛋后,鼻窦症状在大约5年期间有减轻。然而,鼻窦充血和鼻窦感染在随后几年内复发。在本次评估前3年,患者出现持续咳嗽。患者在第二家医院接受了评估,被诊断为细菌性肺炎,并接受了治疗。随后,患者被转诊至第三家医院,接受了鼻窦手术和鼻甲切除术。

在本次评估前约6个月,患者发现每天咳黄白色痰。痰量增多,痰偶尔呈绿色。2个月后,患者在第二家医院接受了其初级诊疗医师的评估。胸部X线片显示支气管扩张,主要位于肺上部和中部。





作者信息

James E. Mojica, M.D., Christopher J. Richards, M.D., Jad S. Husseini, M.D., and Lida P. Hariri, M.D., Ph.D.
From the Departments of Medicine (J.E.M., C.J.R.), Radiology (J.S.H.), and Pathology (L.P.H.), Massachusetts General Hospital, and the Departments of Medicine (J.E.M., C.J.R.), Radiology (J.S.H.), and Pathology (L.P.H.), Harvard Medical School — both in Boston.

 

参考文献

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