Friedman B A, Wenglin B D, Hyland R N, Rifkind D
Am Rev Respir Dis. 1975 Jan;111(1):89-96. doi: 10.1164/arrd.1975.111.1.89.
Two patients with renal transplants were admitted for evaluation of fever. During the course of hospitalization both had hectic fever and arthralgia. Pulmonary symptoms were absent or minimal. In one patient the admitting chest roentgenogram was entirely normal and in the other only a small focal abnormality was apparent. Hypoxemia occurred even in the presence of normal or nearly normal chest roentgenograms. The diagnosis of Pneumocystis carinii infection was made by bronchoscopic brush biopsy in both patients. Therapy with pentamidine isethionate was successful. It is suggested that in patients with renal transplants and in others with similar immonosuppression, even with a normal chest roentgenogram, Pneumocystis carinii infection be considered as the cause of a fever of unknown origin. This should be evaluated initially with blood gas studies; if these are abnormal, further studies, including biopsy, are justified.
两名肾移植患者因发热入院评估。住院期间，两人均出现弛张热和关节痛。无肺部症状或症状轻微。一名患者入院时胸部X线片完全正常，另一名患者仅见一个小的局灶性异常。即使胸部X线片正常或接近正常，仍出现低氧血症。两名患者均通过支气管镜刷检确诊为卡氏肺孢子虫感染。使用戊烷脒治疗成功。建议对于肾移植患者及其他免疫抑制情况相似的患者，即使胸部X线片正常，也应考虑卡氏肺孢子虫感染为不明原因发热的病因。最初应通过血气分析进行评估；如果结果异常，则有理由进行包括活检在内的进一步检查。
