Dereksson Kristjan, Kristjansson Mar, Baldursson Olafur
Skrifstofu kennslu, vísinda og Thróunar, Landspítala Fossvogi, 108 Reykjavík, Iceland.
Laeknabladid. 2007 Sep;93(9):607-13.
A 63 year old woman seeks medical attention for symptoms of fever, headache and increasing dyspnoea. She has a history of psoriatic-arthritis and uses 10 mg/week of methotrexate as arthritic treatment. There is also a history of severe alcohol abuse. She is in respiratory failure, with basal pulmonary crackles and increased serum inflammatory markers, a normal white-cell count but with a lowered lymphocyte count. A CT-scan reveals ground-glass lung changes. Bronchial biopsy reveals the fungus P. jiroveci which infects immunodeficient hosts. After extensive testing it was concluded that the patient's immunodeficiency was attributed to the combination of methotrexate, ethanol and psoriatic-arthritis. In this article, a case of pneumocystis pneumonia is reviewed as well as the infective mechanism of P. jiroveci and host-defence against the fungus. Additionally, symptoms and signs of the infection, diagnostic approach and treatment are reviewed. Because the combination of methotrexate and ethanol played a significant role in the immunodeficiency of the patient, their effect on the immune system is addressed.
一名63岁女性因发热、头痛和呼吸困难加重等症状就医。她有银屑病关节炎病史，使用10毫克/周的甲氨蝶呤进行关节炎治疗。她还有严重酗酒史。她出现呼吸衰竭，肺部有基底啰音，血清炎症标志物升高，白细胞计数正常但淋巴细胞计数降低。CT扫描显示肺部有磨玻璃样改变。支气管活检发现了感染免疫缺陷宿主的耶氏肺孢子菌。经过广泛检查，得出结论，患者的免疫缺陷归因于甲氨蝶呤、乙醇和银屑病关节炎的共同作用。本文回顾了一例肺孢子菌肺炎病例以及耶氏肺孢子菌的感染机制和宿主对该真菌的防御。此外，还回顾了感染的症状和体征、诊断方法及治疗。由于甲氨蝶呤和乙醇的联合作用在患者免疫缺陷中起了重要作用，因此探讨了它们对免疫系统的影响。
