Nishida Ruriko, Mori Yasuo, Iwasaki Hiromi, Tokuyama Takahito, Kamezaki Kenjiro, Nagasaki Yoji, Oka Hideyo, Miyawaki Kohta, Saito Noriyuki, Takenaka Katsuto, Harada Naoki, Miyamoto Toshihiro, Teshima Takanori, Akashi Koichi
Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
Intern Med. 2010;49(14):1441-4. doi: 10.2169/internalmedicine.49.3658. Epub 2010 Jul 15.
The chronic graft-versus-host disease often requires unceasing immunosuppressive therapy (IST), which increases a risk of infectious complications in hematopoietic stem cell transplantation (HSCT) recipients. We report an adult T-cell leukemia/lymphoma case who developed pulmonary nocardiosis, a rare pulmonary complication, after allogeneic HSCT despite administration of the prophylactic trimethoprim-sulfamethoxazole (TMP/STX). The inhaled corticosteroid in addition to systemic IST had been started for bronchiolitis obliterance 4 months prior to nocardiosis development. The patient was successfully treated with an increased dose of TMP/STX combined with meropenem. Transplantation physicians should keep this rare pulmonary complication in mind during sustained IST.
慢性移植物抗宿主病通常需要持续的免疫抑制治疗（IST），这增加了造血干细胞移植（HSCT）受者发生感染并发症的风险。我们报告了1例成人T细胞白血病/淋巴瘤病例，该患者在接受异基因HSCT后，尽管使用了预防性甲氧苄啶-磺胺甲恶唑（TMP/STX），仍发生了罕见的肺部并发症——肺诺卡菌病。在发生诺卡菌病前4个月，已开始使用吸入性糖皮质激素联合全身IST治疗闭塞性细支气管炎。该患者通过增加TMP/STX剂量联合美罗培南成功治愈。移植医生在持续进行IST治疗期间应牢记这种罕见的肺部并发症。
