摘要
目的探讨卡氏肺孢子菌肺炎(pneumocystis pneumonia,PCP)的临床特点及诊治要点,旨在减少临床误漏诊。方法回顾性分析1例肾病综合征并发PCP患者的临床资料,并复习相关文献。结果本例为74岁女性,先后3次因双下肢水肿伴发热、气短入院。首次住院时行肾脏穿刺活检术,确诊为肾病综合征(nephrotlc syndrome,NS),给予糖皮质激素治疗病情缓解。2个月后再次出现双下肢水肿、全身充血性皮疹、瘙痒在某院诊断为药物过敏,给予对症治疗,次日转我院肾病科,仍按NS给予对症支持治疗后病情缓解。2个月后患者因前述症状第3次入住我院肾病科,因胸部CT检查示两肺多发斑片状磨玻璃影、多发微小结节影及条状致密影,经支气管肺泡灌洗液培养检出肺孢子菌孢囊,确诊为PCP。经积极对症抗感染治疗,病情一度缓解,但因患者高龄、病情复杂,病程中出现肺部鲍曼不动杆菌感染,终因呼吸衰竭抢救无效死亡。结论对长期应用糖皮质激素治疗的NS患者,如出现发热伴气短,有肺部感染征兆,应高度警惕是否并发PCP,支气管肺泡灌洗液培养检出肺孢子菌孢囊可作为确诊依据。
Objective To investigate clinical features and key points of diagnosis and treatment of pneumocystis pneumonia （PCP） in order to reduce misdiagnosis and missed diagnosis rates.Methods Clinical data of 1 patient with nephrotic syndrome （NS） complicated with PCP was retrospectively analyzed, and related literature was reviewed.Results A 74 years-old female was admitted for bilateral lower extremity edema, fever and shortness of breath for three times.The patient was diagnosed as having NS by results of renal biopsy of the first time after admission, and 36 mg 1/d Methylprednisolone Tablets was given orally, and the symptoms were relieved.The patient had again bilateral lower extremity edema, systemic congestive skin rash and itching 2 months later, and was diagnosed as having drug allergy in emergency department of other hospital, and symptomatic treatment was followed.The patient was transferred to nephropathy department of our hospital on the next day, and symptomatic treatment for NS was still given, and the condition was alleviated.The patient was admitted to our hospital for the third time because of the above symptoms two months later.Chest CT examination showed that both lungs had multiple patching-like glass opacity shadow, multiple small nodules and strip-like dense shadow, and PCP was confirmed after finding pneumocystis by bronchoalveolar lavage fluid and cultivation.The conditions had been relieved after positively anti infection treatment, however pulmonary infection of acinetobacter baumannii occurred during the course of disease due to advanced age and complicated condition, and the patient died of respiratory failure although active treatment.Conclusion Clinicians should pay more attention to concurrent PCP for NS patients with long-term medication of corticosteroids, who have fever, shortness of breath and signs of pulmonary infection, and pneumocystis detection by bronchoalveolar lavage fluid and cultivation can be used as a diagnostic basis.
出处
《临床误诊误治》
2017年第4期42-45,共4页
Clinical Misdiagnosis & Mistherapy
关键词
肺孢子菌肺炎
肾病综合征
漏诊
Pneumocystis pneumonia
Nephrotic syndrome
Missed diagnosis
