Plakke Michael J, Jalota Leena, Lloyd Benjamin J
Department of Internal Medicine, The Reading Hospital and Medical Center, West Reading, Pennsylvania, USA.
BMJ Case Rep. 2013 Mar 1;2013:bcr2012007912. doi: 10.1136/bcr-2012-007912.
A man in his late 50s with a history of membranoproliferative glomerulonephritis presented with fever and mild dyspnoea. He was HIV-negative and had been on corticosteroids as immunosuppression for 6 months prior to tapering them off 1 week before presentation. He was not taking prophylaxis for Pneumocystis jirovecii pneumonia. After unsuccessful treatment for community-acquired pneumonia, his condition worsened and he required intubation and mechanical ventilation. Full respiratory workup including bronchoscopy revealed P jirovecii as a source for the patient's infection. He was treated successfully with a 21-day course of trimethoprim-sulfamethoxazole and eventually weaned off the ventilator. He has had no complications to date. In our review of this case and the existing literature, we believe that proper utilisation of prophylaxis for pneumocystis pneumonia may have prevented our patient's transfer to intensive care unit. In our article, we discuss this issue and explore current evidence for prophylaxis.
一名50多岁的男性，有膜增生性肾小球肾炎病史，出现发热和轻度呼吸困难。他的HIV检测呈阴性，在出现症状前1周逐渐减少皮质类固醇用量之前，已接受皮质类固醇作为免疫抑制治疗6个月。他未接受针对耶氏肺孢子菌肺炎的预防治疗。在社区获得性肺炎治疗失败后，他的病情恶化，需要插管和机械通气。包括支气管镜检查在内的全面呼吸检查显示，耶氏肺孢子菌是该患者感染的源头。他接受了为期21天的甲氧苄啶-磺胺甲恶唑治疗，最终成功脱机。迄今为止，他没有出现并发症。在我们对该病例和现有文献的回顾中，我们认为正确使用肺孢子菌肺炎预防措施可能会避免我们的患者转入重症监护病房。在我们的文章中，我们将讨论这个问题并探讨当前的预防证据。
