Camara B, Martin-Blondel G, Desloques L, Ould Mohamed A, Rouquette I, Hermant C, Rostaing L, Kamar N
Service de pneumologie, clinique des voies respiratoires, CHU Rangueil-Larrey, 24, chemin-de-Pouvourville, 31059 Toulouse, France.
Rev Pneumol Clin. 2010 Dec;66(6):347-50. doi: 10.1016/j.pneumo.2009.09.004. Epub 2009 Nov 6.
The authors report the association of organizing pneumonia (OP) and a Pneumocystis jiroveci infection in a woman who benefited from a kidney transplant 13 years before and was under corticoids, cyclosporine and mycophenolate mofetil. The diagnosis was based on progressive dyspnoea with fever with an alteration in the general state associated with diffuse micronodular pneumopathy suggesting bronchiolitis. The conformation was obtained by the analysis of the alveolar bronchial washings and the histological examination of the distal biopsies revealing endo-alveolar vegetant fibromas. Transbronchial biopsies may be used for the diagnosis and thereby, avoid an invasive surgical pulmonary biopsy. The aetiology of OP may be related to the immunosuppressant treatment or infection by Pneumocystis jiroveci. The evolution in this case was favourable with trimethoprime and sulfamethoxazole associated with a transient increase in the corticoid treatment. This association is rarely described in patients undergoing solid organ transplants.
作者报告了一名女性患者,她13年前接受了肾移植,一直在使用皮质类固醇、环孢素和霉酚酸酯,出现了机化性肺炎(OP)与耶氏肺孢子菌感染的关联。诊断依据是进行性呼吸困难伴发热,全身状况改变,伴有提示细支气管炎的弥漫性微小结节性肺病。通过肺泡灌洗分析和远端活检的组织学检查发现肺泡内生长性纤维瘤得以确诊。经支气管活检可用于诊断,从而避免进行侵入性的外科肺活检。OP的病因可能与免疫抑制治疗或耶氏肺孢子菌感染有关。该病例经甲氧苄啶和磺胺甲恶唑治疗,并短暂增加皮质类固醇治疗后,病情好转。这种关联在实体器官移植患者中很少见。