Haddad Toufik Mahfood, Vallabhajosyula Saraschandra, Nawaz Muhammad Sarfraz, Vivekanandan Renuga
Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA.
Division of Critical Care Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
BMJ Case Rep. 2015 Aug 26;2015:bcr2015210117. doi: 10.1136/bcr-2015-210117.
Pneumocystis jirovecii is responsible for P. jirovecii pneumonia (PJP) in immunocompromised individuals, with a recent rise of cases noted in non-HIV patients. A middle-aged man presented with new-onset cough, fever, hypoxia and tachypnoea. He was on a tapering course of dexamethasone for amiodarone-induced thyrotoxicosis. He developed worsening airspace disease necessitating mechanical ventilation. Bronchoalveolar lavage (BAL) fluid was positive for P. jirovecii and he was managed with trimethoprim/sulfamethoxazole and pentamidine, but succumbed to cardiorespiratory arrest. One-third of PJP cases occur in non-HIV patients, and have a higher morbidity and mortality. Most immunocompromised patients typically exhibit PJP during a corticosteroid taper. The accurate dose, duration or frequency of steroid use in not well established. Diagnosis of PJP in this population is more challenging due to lower BAL yield with alternate modalities such as serum/BAL β-d-glucan and PCR enhancing the yield. Further studies are needed to highlight PJP prophylaxis in patients with steroid use.
耶氏肺孢子菌可导致免疫功能低下个体发生耶氏肺孢子菌肺炎（PJP），近期非HIV患者中的病例有所增加。一名中年男性出现新发咳嗽、发热、缺氧和呼吸急促。他因胺碘酮诱发的甲状腺毒症正在逐渐减量使用地塞米松。他出现了进行性加重的肺泡腔疾病，需要机械通气。支气管肺泡灌洗（BAL）液耶氏肺孢子菌检测呈阳性，他接受了甲氧苄啶/磺胺甲恶唑和喷他脒治疗，但最终死于心肺骤停。三分之一的PJP病例发生在非HIV患者中，且发病率和死亡率更高。大多数免疫功能低下患者通常在逐渐减量使用皮质类固醇期间出现PJP。目前尚未明确类固醇使用的准确剂量、持续时间或频率。由于血清/BALβ-d-葡聚糖和PCR等替代检测方法提高了检测率，使得该人群中PJP的诊断更具挑战性。需要进一步研究以强调对使用类固醇的患者进行PJP预防。
