Yonemaru M, Homma S, Yamasawa F, Kawai A, Kobayashi H, Ichinose Y, Kanazawa M, Kawashiro T, Yokoyama T
Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1991 Nov;29(11):1499-504.
A 53-year-old male was admitted to Keio University Hospital with a pneumonia shadow in the left lung field and respiratory failure. Because there was progression of respiratory failure, mechanical ventilation was required to maintain appropriate oxygenation. Although erythromycin administration was started at the time of admission, a steroid (prednisolone 60 mg/day) was added a few days later to temporarily inhibit the acute inflammatory response in the lung parenchyma. This intensive therapy resulted in resolution of the patient's pneumonia and improvement of his respiratory failure. No pathogens were detected in the clinical specimens. Indirect immunofluorescence examination demonstrated a marked increase in titers against Legionella pneumophila serogroup 1, which was sufficient to confirm a diagnosis of Legionnaires' disease. The causative organism of this disease, a gram-negative short rod, is rarely cultured on conventional culture media. Two clinical subtypes are known based on clinical manifestations: 1) the Pontiac fever-type in which the predominant symptom is fever alone; and 2) the pneumonia-type which was observed in the epidemic in Philadelphia when the disease was first reported in 1976. The present case of Legionnaires' disease was the severe pneumonia-type which was successfully treated with a combination of erythromycin and a steroid.
一名53岁男性因左肺野出现肺炎阴影及呼吸衰竭入住庆应义塾大学医院。由于呼吸衰竭不断进展，需要机械通气以维持适当的氧合。入院时即开始使用红霉素，数日后加用类固醇（泼尼松龙60mg/天）以暂时抑制肺实质的急性炎症反应。这种强化治疗使患者的肺炎得到缓解，呼吸衰竭也有所改善。临床标本中未检测到病原体。间接免疫荧光检查显示抗嗜肺军团菌血清1型的滴度显著升高，足以确诊军团病。该疾病的病原体为革兰氏阴性短杆菌，在传统培养基上很少能培养出来。根据临床表现已知有两种临床亚型：1）庞蒂亚克热型，主要症状仅为发热；2）肺炎型，1976年该疾病首次报道时在费城的疫情中观察到。本例军团病为严重的肺炎型，通过红霉素和类固醇联合治疗成功治愈。
