Park Se Yoon, Kim Mi Young, Choi Won Jin, Yoon Dok Hyun, Lee Sang-Oh, Choi Sang-Ho, Kim Yang Soo, Suh Cheolwon, Woo Jun Hee, Kim Sung-Han
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
Med Mycol. 2017 Jun 1;55(4):349-357. doi: 10.1093/mmy/myw095.
It is difficult to differentiate Pneumocystis pneumonia (PCP) from rituximab-induced interstitial lung disease (RILD) in lymphoma patients with diffuse pulmonary infiltrates who are receiving rituximab-containing chemotherapy. Using a clinical scoring system, we aim to differentiate PCP from RILD who are receiving rituximab-containing chemotherapy. We reviewed the medical records of lymphoma patients who had received rituximab-containing chemotherapy between 2012 and 2015 in a tertiary hospital. Among 613 lymphoma patients receiving rituximab-containing chemotherapy, 97 (16%) had diffuse pulmonary infiltrates. Of these, 16 (16%) with an alternative diagnosis and 22 (23%) with an indeterminate diagnosis were excluded. Finally, 21 (22%) patients were classified as having PCP and the remaining 38 (39%) as having RILD. Fever, short duration of symptoms (≤5 days), systemic inflammatory response syndrome (SIRS), and severe extent of disease on CT scan (>75%) were more common in patients with PCP than in those with RILD. Clinical scores were determined using the following system: SIRS = score 1, symptom duration ≤5 days = score 1, extent of disease on CT >75% = score 4. A score of ≥2 differentiated PCP from RILD with 91% sensitivity (95% CI, 70-99) and 71% specificity (95% CI, 54-84). A clinical scoring system based on presence of SIRS, short duration of symptoms, and severe extent of disease on CT scan appears to be useful in differentiation of PCP from RILD.
对于接受含利妥昔单抗化疗且出现弥漫性肺部浸润的淋巴瘤患者，很难区分肺孢子菌肺炎（PCP）与利妥昔单抗诱导的间质性肺病（RILD）。我们旨在利用临床评分系统，对接受含利妥昔单抗化疗的PCP和RILD进行鉴别。我们回顾了一家三级医院2012年至2015年间接受含利妥昔单抗化疗的淋巴瘤患者的病历。在613例接受含利妥昔单抗化疗的淋巴瘤患者中，97例（16%）出现弥漫性肺部浸润。其中，16例（16%）有其他诊断，22例（23%）诊断不明确，予以排除。最终，21例（22%）患者被归类为PCP，其余38例（39%）为RILD。发热、症状持续时间短（≤5天）、全身炎症反应综合征（SIRS）以及CT扫描显示疾病严重程度高（>75%）在PCP患者中比在RILD患者中更常见。临床评分采用以下系统确定：SIRS = 1分，症状持续时间≤5天 = 1分，CT上疾病范围>75% = 4分。评分≥2分可鉴别PCP与RILD，敏感性为91%（95%CI，70 - 99），特异性为71%（95%CI，54 - 84）。基于SIRS的存在、症状持续时间短以及CT扫描显示疾病严重程度的临床评分系统似乎有助于区分PCP与RILD。
