Campbell Steven J, Kynyk Jessica A, Davis John A
Department of Pulmonary, Critical Care, and Sleep, Ohio State University College of Medicine, Columbus, Ohio, USA.
Department of Infectious Diseases, Ohio State University College of Medicine, Columbus, Ohio, USA.
BMJ Case Rep. 2017 Jan 17;2017:bcr2016217524. doi: 10.1136/bcr-2016-217524.
A previously healthy young man with a rare genetic condition presented with severe acute respiratory distress syndrome secondary to pneumonia with septic shock. He did not improve with conventional therapy for his known causal organism thus prompting further workup. He was found to be profoundly immunosuppressed raising our suspicion for atypical organisms. A bronchoalveolar lavage sample was positive via PCR for adenovirus which we suspect exacerbated a pre-existing bacterial pneumonia and led to a severe and non-responsive respiratory failure. His serum adenovirus load was markedly elevated. Treatment was started once the diagnosis of disseminated adenovirus infection was made; however, at that time patient was suffering from refractory hypoxaemia, respiratory acidosis, right heart failure and septic shock. Despite maximal supportive measures our patient ultimately expired over the course of 6 days.
一名患有罕见遗传疾病的既往健康年轻男性，因肺炎继发感染性休克出现严重急性呼吸窘迫综合征。针对其已知致病微生物的常规治疗未能使其病情改善，因此促使进一步检查。发现他存在严重免疫抑制，这增加了我们对非典型病原体的怀疑。支气管肺泡灌洗样本经聚合酶链反应检测腺病毒呈阳性，我们怀疑这加剧了先前存在的细菌性肺炎，并导致严重且无反应的呼吸衰竭。他的血清腺病毒载量显著升高。一旦确诊为播散性腺病毒感染，即开始治疗；然而，当时患者已出现难治性低氧血症、呼吸性酸中毒、右心衰竭和感染性休克。尽管采取了最大程度的支持措施，我们的患者最终在6天内死亡。
