Shimoyama Yuichiro, Umegaki Osamu, Ooi Yukimasa, Agui Tomoyuki, Kadono Noriko, Minami Toshiaki
1Department of Anesthesiology, Osaka Medical College, Intensive Care Unit, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686 Japan.
2Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan.
JA Clin Rep. 2017;3(1):25. doi: 10.1186/s40981-017-0096-3. Epub 2017 May 8.
() rarely causes lower respiratory tract infections, although most reported cases of pneumonia are fatal despite intensive antibiotic therapy. We present a case of pneumonia in an immunocompetent patient.
An 81-year-old woman was transferred from a district general hospital to our hospital for treatment of congestive heart failure. The patient presented with a nonproductive cough, dyspnea, edema in both lower extremities, orthopnea, fever, and occult blood in the stool. A chest radiograph indicated bilateral pleural effusion and pulmonary congestion. After diuretic therapy and chest drainage, bilateral pleural effusion and pulmonary congestion improved. On day 2, she experienced severe respiratory distress. was isolated from two blood sample cultures. On day 4, her condition had progressed to severe respiratory distress (PaO/FiO ratio = 108). A chest radiograph and computed tomography indicated extensive bilateral infiltrates. She was transferred to the intensive care unit and was intubated. was also isolated from five blood sample cultures at that time. After isolating , we switched antibiotics to a combination of imipenem and levofloxacin, which were effective. She had no history of immunodeficiency, surgery, ill close contacts, risk factors for HIV or tuberculosis, recent central venous catheter insertion, or anthrax vaccination. She improved and was discharged from the intensive care unit after several days.
This is a rare case of pneumonia in an immunocompetent patient, who subsequently recovered. should be considered as a potential pathogen when immunocompetent patients develop severe pneumonia.
（）很少引起下呼吸道感染，尽管大多数报告的肺炎病例尽管接受了强化抗生素治疗仍会致命。我们报告一例免疫功能正常患者的肺炎病例。
一名81岁女性因充血性心力衰竭从一家地区综合医院转入我院治疗。患者表现为干咳、呼吸困难、双下肢水肿、端坐呼吸、发热及大便潜血。胸部X线片显示双侧胸腔积液和肺充血。经过利尿治疗和胸腔引流后，双侧胸腔积液和肺充血有所改善。第2天，她出现严重呼吸窘迫。从两份血培养样本中分离出（）。第4天，她的病情进展为严重呼吸窘迫（动脉血氧分压/吸入氧分数比= 108）。胸部X线片和计算机断层扫描显示双侧广泛浸润。她被转入重症监护病房并进行了气管插管。当时从五份血培养样本中也分离出（）。分离出（）后，我们将抗生素换为亚胺培南和左氧氟沙星联合使用，治疗有效。她没有免疫缺陷、手术、密切接触者患病、感染HIV或结核病的危险因素、近期中心静脉导管插入史或炭疽疫苗接种史。几天后她病情好转并从重症监护病房出院。
这是一例免疫功能正常患者发生的罕见的（）肺炎病例，该患者随后康复。当免疫功能正常的患者发生严重肺炎时，应将（）视为潜在病原体。
