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1例红斑性天疱疮并发重症肺炎患者因基础疾病使用激素及免疫抑制剂，出现气短、发热及干咳等症状，胸部CT提示双肺弥漫性磨玻璃样渗出，实验室检查提示CD4+细胞80 cells/μL，真菌D289 pg/mL，初步治疗予以复方磺胺甲噁唑口服，但病情恶化需有创呼吸支持，肺泡灌洗液宏基因二代测序(metagenomics next-generation sequencing,m NGS)明确为耶氏肺孢子菌感染，治疗方案调整为静脉复方磺胺甲噁唑联合卡泊芬净，并采取肺保护通气策略，动态评估镇痛镇静，最终治疗成功。此病例显示耶氏肺孢子菌为重症肺炎的特殊病原体，疾病特点及治疗有其特殊性。复方磺胺甲噁唑疗效评估需独特考量，氧合指数恶化不代表治疗无效。需持续、动态地评估症状、体征及实验室检查结果，CD4+细胞计数上升和真菌D水平下降可能提示治疗有效，胸部影像学的改善往往滞后于临床症状的好转。
Abstract：One case of erythematosquamous pemphigus complicated with severe pneumonia was reported. The patient had underlying diseases treated with steroids and immunosuppressants and presented with symptoms of dyspnea, fever, and dry cough. Chest CT showed diffuse ground glass opacities in both lungs, and laboratory tests showed CD4+ cells at 80 cells/μL and fungal D-dimer at 289 pg/mL. Initial treatment with compound sulfamethoxazole was given, but the patient's condition deteriorated and required invasive respiratory support.Bronchoalveolar lavage fluid mNGS confirmed infection with Yeohella sp. The treatment plan was adjusted to the intravenous compound sulfamethoxazole combined with a carbapenem, and a lung-protective ventilation strategy was adopted. Dynamic assessment of pain and sedation was performed, and the patient was eventually treated successfully. This case demonstrates that Yeohella sp. is a special pathogen of severe pneumonia with its own characteristics and treatment. The efficacy of the compound sulfamethoxazole should be evaluated uniquely,as deterioration of the oxygenation index does not necessarily indicate treatment failure. Continuous, dynamic evaluation of symptoms, physical examination findings, and laboratory test results is needed, with an increase in CD4+ cell count and a decrease in fungal D levels potentially indicating treatment efficacy. Improvement in chest imaging is often delayed compared to clinical symptom improvement.
[1] Thomas,Limper. Pneumocystis pneumonia[J]. N Engl J Med,2004,350(24):2487-2498.
[2] Gigliotti. Pneumocystis carinii nomenclature:response to cushion and stringer[J]. Clin Infect Dis,2006,42(8):1208-1209.
[3] Yale,Limper. Pneumocystis carinii pneumonia in patients without acquired immunodeficiency syndrome:associated illness and prior corticosteroid therapy[J]. Mayo Clin Proc,1996,71(1):5-13.
[4] Sepkowitz,Brown,Telzak,et al. Pneumocystis carinii pneumonia among patients without AIDS at a cancer hospital[J]. Jama,1992,267(6):832-837.
[5] Torres,Chemaly,Storey,et al. Influence of type of cancer and hematopoietic stem cell transplantation on clinical presentation of Pneumocystis jiroveci pneumonia in cancer patients[J]. Eur J Clin Microbiol Infect Dis,2006,25(6):382-388.
[6] Overgaard,Helweg-Larsen. Pneumocystis jiroveci pneumonia(PCP)in HIV-1-negative patients:a retrospective study 2002-2004[J]. Scand J Infect Dis,2007,39(6-7):589-595.
[7] Leggiadro,Winkelstein,Hughes. Prevalence of Pneumocystis carinii pneumonitis in severe combined immunodeficiency[J]. J Pediatr,1981,99(1):96-98.
[8] Hanachi,Bohem,Bemer,et al. Negative role of malnutrition in cell-mediated immune response:pneumocystis jirovecii pneumonia(PCP)in a severely malnourished,HIV-negative patient with anorexia nervosa[J]. Clin Nutr ESPEN,2018,(25):163-165.
[9] Kadoya,Okada,Iikuni,et al. Risk factors for Pneumocystis carinii pneumonia in patients with polymyositis/dermatomyositis or systemic lupus erythematosus[J]. J Rheumatol,1996,23(7):1186-1188.
[10] de Boer,de Fijter,Kroon. Outbreaks and clustering of Pneumocystis pneumonia in kidney transplant recipients:a systematic review[J]. Med Mycol,2011,49(7):673-680.
[11] Vanek,Jirovec. Parasitic pneumonia.Interstitial plasma cell pneumonia of premature,caused by pneumocystis carinii[J].Zentralbl Bakteriol Orig,1952,158(1-2):120-127.
[12] Ponce,Gallo,Bustamante,et al. Pneumocystis colonization is highly prevalent in the autopsied lungs of the general population[J]. Clin Infect Dis,2010,50(3):347-353.
[13] Roblot,Godet,Le Moal,et al. Analysis of underlying diseases and prognosis factors associated with Pneumocystis carinii pneumonia in immunocompromised HIV-negative patients[J]. Eur J Clin Microbiol Infect Dis,2002,21(7):523-531.
[14] Bateman,Oladele,Kolls. Diagnosing pneumocystis jirovecii pneumonia:a review of current methods and novel approaches[J]. Med Mycol,2020,58(8):1015-1028.
[15] Liana,Samosir,Sari,et al. CD4+and CD8+cell counts are significantly correlated with absolute lymphocyte count in hospitalized COVID-19 patients:a retrospective study[J].2023(11):e15509.
[16]蒋丽华,李宏军,王仁贵.艾滋病合并肺孢子菌肺炎的CT表现与CD4+T淋巴细胞计数的关系[J].中国煤炭工业医学杂志,2016,19(6):831-835.
[17] Huang,Yi,Song,et al. Negative serum(1,3)-β-D-glucan has a low power to exclude Pneumocystis jirovecii pneumonia(PJP)in HIV-uninfected patients with positive qPCR[J].Ann Clin Microbiol Antimicrob,2023,22(1):102.
[18] Morjaria,Frame,Franco-Garcia,et al. Clinical performance of(1,3)beta-D glucan for the diagnosis of pneumocystis pneumonia(PCP)in cancer patients tested with PCP polymerase chain reaction[J]. Clin Infect Dis,2019,69(8):1303-1309.
[19]祝颖,张利平,朱明辉,等.宏基因组二代测序在非HIV感染患者耶氏肺孢子菌肺炎诊疗中的应用[J].武汉大学学报(医学版),2024,45(5):576-581,588.
[20]徐庆庆,邱晓华,丁晶晶,等.结合外周血宏基因组二代测序诊断的7例重症非人类免疫缺陷病毒感染者肺孢子菌肺炎临床分析[J].国际呼吸杂志,2022,42(20):1543-1549.
[21] Cooley,Dendle,Wolf,et al. Consensus guidelines for diagnosis, prophylaxis and management of Pneumocystis jirovecii pneumonia in patients with haematological and solid malignancies,2014[J]. Intern Med J,2014,44(12b):1350-1363.
[22] Maschmeyer,Helweg-Larsen,Pagano,et al. ECIL guidelines for treatment of Pneumocystis jirovecii pneumonia in nonHIV-infected haematology patients[J]. J Antimicrob Chemother,2016,71(9):2405-2413.
[23]宋贤,普琳梅,马翠莲,等.复方磺胺甲唑联合卡泊芬净治疗卡氏肺孢子菌肺炎疗效和安全性的Meta分析[J].医药导报,2017,36(12):1415-1418.
[24] Limper,Offord,Smith,et al. Pneumocystis carinii pneumonia.differences in lung parasite number and inflammation in patients with and without AIDS[J]. Am Rev Respir Dis,1989,140(5):1204-1209.
[25] Vogel,Vatlach,Weissgerber,et al. HRCT-features of Pneumocystis jiroveci pneumonia and their evolution before and after treatment in non-HIV immunocompromised patients[J].Eur J Radiol,2012,81(6):1315-1320.
基本信息:
DOI：10.20256/j.cnki.zgdxbl.20250303.017
中图分类号:R563.1
引用信息:
[1]骆艳妮,侯彦丽,王晓倩,等.成功救治重症耶氏肺孢子菌肺炎患者1例[J].中国典型病例大全,2025,19(01):1-7.DOI:10.20256/j.cnki.zgdxbl.20250303.017.
基金信息: