Craker L R
Department of Anaesthesia, Burton Hospitals NHS Foundation Trust, Burton-on-Trent, UK.
BMJ Case Rep. 2010 Oct 22;2010:bcr0620103111. doi: 10.1136/bcr.06.2010.3111.
We report the case of a 64-year-old man who had received a heart transplant 9 years previously and was on long-term immunosuppression. He was referred to the intensive care unit of our district general hospital with acute respiratory distress and was diagnosed with community-acquired pneumonia. He was treated with antimicrobials, whose spectrum was extended empirically to cover Pneumocystis jiroveci, and respiratory support was provided with continuous positive airway pressure (CPAP). PCR analysis subsequently confirmed a diagnosis of pneumocystis pneumonia (PCP). Despite appropriate therapy the patient unfortunately died 8 days after admission to the unit. To the author's knowledge, this is the first report in the literature of such a late presentation of PCP after cardiac transplantation. We discuss current diagnostic and treatment strategies for PCP.
我们报告了一例64岁男性患者的病例，该患者9年前接受了心脏移植手术，一直在接受长期免疫抑制治疗。他因急性呼吸窘迫被转诊至我们地区综合医院的重症监护病房，被诊断为社区获得性肺炎。给予其抗菌药物治疗，经验性扩大抗菌谱以覆盖耶氏肺孢子菌，并采用持续气道正压通气（CPAP）提供呼吸支持。随后的PCR分析证实诊断为肺孢子菌肺炎（PCP）。尽管进行了适当治疗，但患者在入住该病房8天后不幸死亡。据作者所知，这是文献中首例心脏移植术后如此晚期出现PCP的报告。我们讨论了PCP目前的诊断和治疗策略。
