흉부 방선균증 = Thoracic Actinomycosis

다국어 초록 (Multilingual Abstract)

Background: Thoracic actinomycosis is a rare, chronic debilitating disease and it is difficult to diagnose and treat. Material and Method: Between March 1990 to December 2003, 17 patients were diagnosed and treated for actinomycosis in our center. Except 4 patients (involving cervicofacial, and abdominopelvic area), we reviewed the clinical characteristics, diagnosis method, and treatment in 13 patients. Result: In 8 patients, the operation was required for diagnosis and treatment. 7 of 8 patients had tumor-like lesions in radiological findings and they were not distinguished as lung cancer, and 1 of 8 patients was non-responsive to the antibiotics therapy. Among the 5 medically treated patients, 4 of 5 patients were diagnosed by bronchoscopic biopsy and one by CT-guided biopsy. All of them was well-responsive by the antibiotic treatment. Conclusion: Thoracic actinomycosis is a chronic inflammatory disease that respond well to antibiotics (penicillin therapy). It should be diagnosed by the repeated biopsy (CT-guided or bronchoscopic) before starting treatment. However, if the lesion is not distinguished as the lung cancer, non-responsive to the medical treatment, and the patients experience the recurrent hemoptysis, we can consider the operation for the diagnosis and treatment.

국문 초록 (Abstract)

배경: 흉부 방선균증은 비교적 희귀한 만성 질환으로 정확한 진단과 치료에 어려움이 있다. 대상 및 방법: 1990년 3월부터 2003년 12월까지 본 원에서 방선균증으로 진단 및 치료를 받은 환자는 모두 17명이었고, 이 중 경안면부 및 복부골반부를 침범한 4명을 제외한 13명의 환자를 대상으로 하였고, 이들의 임상적인 특징 및 진단방법 및 치료에 대해 비교 조사하였다. 결과: 8명의 환자에서 수술적인 진단 및 치료를 시행하였고, 이 중 7명의 환자는 흉부 방사선 소견상 폐 종양같은 병변을 보였으며, 나머지 1명은 폐렴양상을 보였으나 항생제 치료에 반응을 하지 않아 수술적인 진단, 및 치료를 시행하였다. 약물치료를 받은 5명의 환자 중 4명은 기관지경하 생검으로, 1명은 CT-guided 생검으로 진단하였고, 모두 항생제 치료에 잘 반응을 하였다. 결론: 흉부 방선균증은 항생제(penicillin 계열)에 잘 반응하는 만성 염증성 질환으로 반복적인 생검을 통해 정확한 진단을 하여야 하며, 종양과 구별이 잘 되지 않거나, 항생제 치료에 반응을 하지 않을 때, 반복적인 객혈이 있을 때에는 수술적인 진단 및 치료를 고려해야 한다.

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