Tsuboi E, Narui K, Nakatani T, Nakamori Y, Nakata K, Muto Y, Sugi H
Department of Respiratory Medicine, Toranomon Hospital.
Nihon Kyobu Shikkan Gakkai Zasshi. 1992 Dec;30(12):2112-7.
A 40-year-old man was admitted with high fever and cough. Pneumonic shadows of the left middle and lower lung fields increased rapidly, and his blood gases worsened. Initial treatment with cefmenoxime, piperacillin, and minocycline was ineffective. Administration of rifampicin was started for suspected legionella pneumonia, but it did not control the spread of the pneumonia shadows. After addition of an antifungal agent and trimethoprim-sulfamethoxazole, his symptoms gradually improved. Isolation of Legionella pneumophila from sputum specimens collected on the 4th day of admission confirmed the diagnosis on day 10. The patient was then given oral rifampicin plus cefmenoxime to prevent mixed infection, and showed a satisfactory improvement. Legionella pneumonia developed secondary to compromise of the patient's immunity due to steroid therapy for MDS. After recovering from Legionella pneumonia, the patient subsequently developed tuberculous pleurisy and Pneumocystis carinii pneumonia, which were cured by antituberculous therapy and trimethoprim-sulfamethoxazole. However, acute hepatitis followed by hepatic failure developed, and he died on day 121 after admission.
一名40岁男性因高热和咳嗽入院。左中下肺野的肺炎阴影迅速增多，其血气情况恶化。最初使用头孢甲肟、哌拉西林和米诺环素治疗无效。因怀疑军团菌肺炎开始使用利福平，但未能控制肺炎阴影的扩散。加用抗真菌药和复方磺胺甲恶唑后，他的症状逐渐改善。入院第4天采集的痰标本分离出嗜肺军团菌，在第10天确诊。随后给予患者口服利福平加头孢甲肟以预防混合感染，病情改善良好。该患者因骨髓增生异常综合征接受类固醇治疗导致免疫力受损，继发军团菌肺炎。从军团菌肺炎康复后，患者随后又患上结核性胸膜炎和卡氏肺孢子虫肺炎，经抗结核治疗和复方磺胺甲恶唑治愈。然而，随后出现急性肝炎并发展为肝衰竭，他在入院第121天死亡。
