Chen Hsuan-Wei, Zheng Jing-Quan, Lin Te-Yu
Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan.
Rev Chilena Infectol. 2012 Feb;29(1):114-5. doi: 10.4067/S0716-10182012000100020. Epub 2012 Apr 10.
We report the case of a 27-year-old man with a history of diabetes mellitus who presented with conscious disturbance, fever, and stiff neck after upper respiratory tract infection. Following diagnosis of meningoencephalitis, antibiotic therapy and deamethasone was initiated. He received endotracheal tube intervention under mechanical ventilation in the intensive care unit, and underwent successful weaning on day 4. One week later, he was diagnosed with pneumonia and a rapidly progressing lung empyema with abscess formation was noted. Microbiological culture of the pleural fluid revealed the presence of Pseudomonas aeruginosa. Nosocomial pneumonia is often caused by Staphylococcus aureus and P. aeruginosa; however, the latter often causes bronchopneumonia rather than fulminant empyema or lung abscess formation. The underlying diabetes mellitus and the history of steroid therapy may explain the present condition of this patient. The possibility of P. aeruginosa being the causative agent should be considered during differential diagnosis in patients presenting with fulminant lung empyema, especially in immunocompromised patients.
我们报告了一名27岁男性患者的病例，该患者有糖尿病病史，在上呼吸道感染后出现意识障碍、发热和颈部僵硬。诊断为脑膜脑炎后，开始使用抗生素治疗和地塞米松。他在重症监护病房接受了机械通气下的气管插管干预，并于第4天成功脱机。一周后，他被诊断为肺炎，并发现有迅速进展的肺脓肿形成的肺脓胸。胸腔积液的微生物培养显示存在铜绿假单胞菌。医院获得性肺炎通常由金黄色葡萄球菌和铜绿假单胞菌引起；然而，后者常引起支气管肺炎，而非暴发性脓胸或肺脓肿形成。潜在的糖尿病和类固醇治疗史可能解释了该患者的现状。在出现暴发性肺脓胸的患者，尤其是免疫功能低下的患者的鉴别诊断中，应考虑铜绿假单胞菌作为病原体的可能性。
