Tuberculosis and Respiratory Diseases

  • 제58권6호
  • /
  • Pages.576-581
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  • 2005
  • /
  • 1738-3536(pISSN)
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  • 2005-6184(eISSN)
대한결핵및호흡기학회 (The Korean Academy of Tuberculosis and Respiratory Diseases)
권호 표지

기관지 방선균증의 임상적 고찰

Diagnosis and Treatment of Endobronchial Actinomycosis

  • 최재철 (성균관대학교 의과대학 내과학교실 삼성서울병원 호흡기내과) ;
  • 고원중 (성균관대학교 의과대학 내과학교실 삼성서울병원 호흡기내과) ;
  • 권용수 (성균관대학교 의과대학 내과학교실 삼성서울병원 호흡기내과) ;
  • 류연주 (성균관대학교 의과대학 내과학교실 삼성서울병원 호흡기내과) ;
  • 유창민 (성균관대학교 의과대학 내과학교실 삼성서울병원 호흡기내과) ;
  • 전경만 (성균관대학교 의과대학 내과학교실 삼성서울병원 호흡기내과) ;
  • 강은해 (성균관대학교 의과대학 내과학교실 삼성서울병원 호흡기내과) ;
  • 서지영 (성균관대학교 의과대학 내과학교실 삼성서울병원 호흡기내과) ;
  • 정만표 (성균관대학교 의과대학 내과학교실 삼성서울병원 호흡기내과) ;
  • 김호중 (성균관대학교 의과대학 내과학교실 삼성서울병원 호흡기내과) ;
  • 권오정 (성균관대학교 의과대학 내과학교실 삼성서울병원 호흡기내과) ;
  • 김태성 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 이경수 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 한정호 (성균관대학교 의과대학 삼성서울병원 병리과)
  • Choi, Jae Chol (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Koh, Won-Jung (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kwon, Yong Soo (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ryu, Yon Ju (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yu, Chang-Min (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jeon, Kyeongman (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kang, Eun Hae (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Suh, Gee Young (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Chung, Man Pyo (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Hojoong (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kwon, O Jung (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Tae Sung (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Kyung Soo (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Han, Joungho (Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 투고 : 2005.03.08
  • 심사 : 2005.05.03
  • 발행 : 2005.06.30
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초록

배 경 : 기관지 방선균증은 매우 드문 질환이다. 본 연구는 최근 10년간 조직학적으로 진단된 7명의 기관지 방선균증 환자의 임상상과 치료에 대해 살펴보고자 하였다. 대상 및 방법 : 1994년 10월부터 2003년 12월까지 삼성서울병원에 내원하여 기관지 방선균증으로 진단된 7명의 임상적, 방사선학적 특징과 치료에 대해 후향적 분석을 시행하였다. 결 과 : 기침과 가래가 가장 흔한 임상증상이었다. 진단까지의 기간은 중앙값 4개월(범위 1-16개월)이었다. 흉부 방사선 소견은 기관지내 종괴와 동반된 경화 또는 무기폐가 6명에서 관찰되었고 1명에서 기관지내 결절이 관찰되었으며, 이중 5명에서 기관지결석이 동반되었다. 이들 환자의 정주용 항생제 사용기간은 중앙값 3일(범위 0-12일)이었으며, 경구용 항생제 사용 기간은 중앙값 147일(범위 20-412일)이었고, 2명의 환자는 정주용 항생제를 사용하지 않았다. 모든 환자에서 치료 후 임상적, 방사선학적으로 호전의 소견을 보였다. 결 론 : 기관지결석을 동반한 기관지내 병변이 있을 때 기관지 방선균증을 의심하여야 한다. 항생제 치료기간은 병변의 진행 정도, 치료에 대한 반응 등을 고려하여 개별화할 수 있을 것이며, 모든 환자에서 2-6주의 정주용 항생제에 이은 6-12개월의 경구용 항생제의 사용이 필요하지는 않을 것이다.

Background : Thoracic actinomycosis is a relatively uncommon anaerobic infection caused by Actinomyces israelii. There have been only a few case reports of endobronchial actinomycosis. The aim of this study was to evaluate the clinical manifestation and treatment of endobronchial actinomycosis. Material and Methods : Seven patients with endobronchial actinomycosis, who were diagnosed in the past 10 years, were retrospectively reviewed. Results : Cough and sputum were the most common symptoms. The chest radiograph and computed tomography showed necrotic consolidation (n=3), atelectasis (n=2), mass (n=1) and an endobronchial nodule (n=1). Proximal broncholithiasis was observed in five patients. All cases were initially suspected to have either lung cancer or tuberculosis. In these patients, the median duration of intravenous antibiotics was 3 days (range 0-12 days) and the median duration of oral antibiotics was 147 days (range 20-412 days). Two patients received oral antibiotic therapy only. There was no clinical evidence of a recurrence. Conclusion : Endobronchial actinomycosis frequently manifests as a proximal obstructive calcified endobronchial nodule that is associated with distal post-obstructive pneumonia. The possibility of endobronchial actinomycosis is suggested when findings of broncholithiasis are present at chest CT. The traditional recommendation of 2-6 weeks of intravenous antibiotics and 6-12 months of oral antibiotic therapy are not necessarily essential in all cases of endobronchial actinomycosis.

키워드

참고문헌

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