Reynolds Timothy David, Thomas Jose
University Hospital of Wales, Cardiff, UK.
BMJ Case Rep. 2013 May 31;2013:bcr2013009299. doi: 10.1136/bcr-2013-009299.
A 57-year-old woman presented to the admissions unit with a 2-month history of malaise, chest tightness and non-productive cough. An outpatient chest radiograph arranged by her general practitioner was reported as showing 'changes in keeping with a severe chest infection' and she had been started on oral antibiotics but her clinical condition subsequently deteriorated. On admission she was febrile (39.2°C) and her oxygen saturation was 99% on 60% oxygen via facemask (rapidly desaturating when supplementary oxygen was removed). Auscultation revealed fine mid-late inspiratory crackles over both lung bases. It transpired that 4 months prior to the onset of symptoms she had been started on nitrofurantoin for prophylaxis against urinary tract infections. The nitrofurantoin was stopped and she was started on prednisolone. Her fever and oxygen saturation gradually improved and she was discharged home after 11 days in the hospital. Her improvement was sustained on outpatient review 8 months later.
一名57岁女性因2个月的全身不适、胸闷和干咳症状入住收治病房。其全科医生安排的门诊胸部X光片报告显示“符合严重胸部感染的变化”，她开始口服抗生素治疗，但临床状况随后恶化。入院时，她发热（39.2°C），通过面罩吸氧60%时血氧饱和度为99%（去除辅助氧气后迅速降低）。听诊发现双肺底部有中晚期吸气末细湿啰音。结果发现，在症状出现前4个月，她开始服用呋喃妥因预防尿路感染。停用呋喃妥因，开始使用泼尼松龙治疗。她的发热和血氧饱和度逐渐改善，住院11天后出院回家。8个月后的门诊复查显示她持续好转。
