Bouslama K, Lebas J, Guidet B, Denis M, Cabane J, Picard O, Wattiaux M J, Giral P, Mayaud C, Imbert J C
Service de Médecine Interne, Hôpital Saint-Antoine, Paris.
Ann Med Interne (Paris). 1990;141(2):179-82.
Two cases are reported of atypical relapses of pneumocystosis in AIDS patients treated with aerosol pentamidine for 14 and 22 months. These pneumopathies are unusual because of their pitted aspect and recurrent spontaneous pneumothoraxes in spite of repeated drainage. They are difficult to diagnose because bronchoalveolar lavage fluid is negative for Pneumocystis carinii, despite their presence in lung biopsies. Histological lesions vary, being granulomatous, necrotizing and invasive, with involvement of the pleura and lymph nodes. Although a highly effective therapy against P. carinii pneumonia, aerosol pentamidine may play a role in these atypical episodes: either by causing bronchial obstructions beyond which the pneumocytotic lesions cannot be reached by lavage and become necrotic, or by favoring the extrapulmonary spread of P. carinii.
报告了两例艾滋病患者非典型肺孢子菌病复发的病例，这两名患者接受雾化喷他脒治疗分别达14个月和22个月。这些肺病不同寻常，因其呈现出凹陷外观，且尽管反复引流仍反复出现自发性气胸。它们难以诊断，因为尽管肺活检中存在卡氏肺孢子菌，但支气管肺泡灌洗液中该菌呈阴性。组织学病变各异，有肉芽肿性、坏死性和浸润性病变，累及胸膜和淋巴结。尽管雾化喷他脒是治疗卡氏肺孢子菌肺炎的高效疗法，但它可能在这些非典型病例中起作用：要么是通过造成支气管阻塞，使得灌洗无法触及肺孢子菌病变部位并使其坏死，要么是通过促使卡氏肺孢子菌发生肺外播散。
