Tanaka Gen-ichi, Nagatomo Yasuhiro, Kai Yasufumi, Matsuyama Mikitaro, Kuroki Masayuki, Sasaki Takashi, Murai Koichi, Okayama Akihiko, Tsubouchi Hirohito
Department of Internal Medicine II, Miyazaki Medical College.
Kansenshogaku Zasshi. 2002 Dec;76(12):1040-4. doi: 10.11150/kansenshogakuzasshi1970.76.1040.
Mycoplasma pneumoniae (M. pneumoniae) pneumonia is a common disease which usually shows a good prognosis, however, it can develop a very serious state such as respiratory distress syndrome. We experienced 2 cases with M. pneumoniae pneumonia from identical twin sisters. Case 1, who was 22 years-old and was the senior sister of the twin, complained of fever and cough on August 1st, 1999. Her chest radiograph revealed consolidation in the right lung. When she was admitted to our hospital on August 11, she revealed severe hypoxemia and the titer to M. pneumoniae was markedly elevated. She was diagnosed as M. pneumoniae pneumonia with acute respiratory distress syndrome and treated with clarithromycin and methylprednisolone. Although it was necessary for her to be in the intensive care unit for 8 days, her condition gradually improved and was discharged on the 30th of September. Case 2, who was the younger sister of Case 1, complained cough and fever on August 21, 1999. Her chest radiograph showed consolidation in the left lung. She was treated by sparfloxacin because the intrafamilial infection of M. pneumoniae was most likely. The diagnosis was confirmed by the increased antibody-titer to M. pneumoniae later. There have been several reports that hyperimmune reaction may be related with the worse course of M. pneumoniae pnuemonia. However, the clinical courses of twin sisters, who should be very similar in their immune response to the same antigen, were very different from each other. The time of administration of effective antibiotics seemed to be a crucial factor to determine their courses. These results emphasized the importance of early diagnosis of the patients with M. pneumoniae pneumonia and the adequate chemotherapy to prevent developing severe respiratory failure.
肺炎支原体肺炎是一种常见疾病，通常预后良好，然而，它可能发展为非常严重的状态，如呼吸窘迫综合征。我们诊治了一对同卵双胞胎姐妹患肺炎支原体肺炎的病例。病例1，22岁，是双胞胎中的姐姐，于1999年8月1日出现发热和咳嗽。她的胸部X线片显示右肺实变。8月11日她入院时，出现严重低氧血症，肺炎支原体滴度显著升高。她被诊断为肺炎支原体肺炎合并急性呼吸窘迫综合征，接受了克拉霉素和甲泼尼龙治疗。尽管她在重症监护病房住了8天，但病情逐渐好转，于9月30日出院。病例2是病例1的妹妹，于1999年8月21日出现咳嗽和发热。她的胸部X线片显示左肺实变。由于很可能是家庭内肺炎支原体感染，她接受了司帕沙星治疗。后来肺炎支原体抗体滴度升高证实了诊断。有几份报告指出，超敏反应可能与肺炎支原体肺炎的病情加重有关。然而，这对双胞胎姐妹对同一抗原的免疫反应应该非常相似，但其临床病程却大不相同。有效抗生素的使用时间似乎是决定她们病程的关键因素。这些结果强调了肺炎支原体肺炎患者早期诊断和适当化疗以预防严重呼吸衰竭发生的重要性。
