Bretzing Douglas, Lat Tasnim, Shakespeare Andrew, Lee Mary, Surani Salim, Ghamande Shekhar
Scott & White Healthcare and Texas A&M Health Science Center, College of Medicine, Texas, USA.
Texas A&M Health Science Center, College of Medicine, Texas, USA.
Case Rep Pulmonol. 2018 Jun 12;2018:4761725. doi: 10.1155/2018/4761725. eCollection 2018.
Patients with human immunodeficiency virus (HIV) have an increased risk of inoculation with nontyphoid compared to the general population. While nontyphoid commonly manifests as gastroenteritis, bacteremia can be seen in patients with HIV. We present a case of disseminated in a patient with HIV complicated by bronchopleural fistula and secondary empyema. A 40-year-old African American male with HIV noncompliant with HAART therapy presented with complaints of generalized weakness, weight loss, cough, night sweats, and nonbloody, watery diarrhea of four weeks' duration. A computed tomography (CT) scan demonstrated a bilobed large, thick-walled cavitary lesion in the right upper lobe communicating with the pleural space to form a bronchopleural fistula. Thoracentesis yielded growth of nontyphi species consistent with empyema; he was treated with intravenous Ceftriaxone and underwent placement of chest tube for drainage of empyema with instillation of alteplase/dornase twice daily for three days. Repeat CT chest showed a hydropneumothorax. The patient subsequently underwent video-assisted thoracoscopy with decortication. The patient continued to improve and follow-up CT chest demonstrated improved loculated right pneumothorax with resolution of the right bronchopleural fistula and resolution of the cavitary lesions. We describe one of the few cases of development of bronchopulmonary fistula and the formation of empyema in the setting of disseminated . Empyema complicated by bronchopulmonary fistula likely led to failure of intrapleural fibrinolytic therapy and the patient ultimately required decortication in addition to antibiotics. While bacteremia can be seen in immunocompromised patients, extraintestinal manifestations of infection such as empyema and bronchopleural fistulas are uncommon. Bronchopleural fistulas most commonly occur as a postoperative complication of pulmonary resection. . This case highlights the unusual pulmonary manifestations that can occur due to disseminated in an immunocompromised patient as well as complex management decisions related to these complications.
与普通人群相比，感染人类免疫缺陷病毒（HIV）的患者感染非伤寒沙门氏菌的风险更高。虽然非伤寒沙门氏菌通常表现为肠胃炎，但HIV患者也可能出现菌血症。我们报告一例HIV患者发生播散性非伤寒沙门氏菌感染，并发支气管胸膜瘘和继发性脓胸。一名40岁的非洲裔美国男性HIV患者，未遵医嘱接受高效抗逆转录病毒治疗（HAART），出现全身乏力、体重减轻、咳嗽、盗汗以及持续四周的非血性水样腹泻。计算机断层扫描（CT）显示右上叶有一个双叶大的厚壁空洞性病变，与胸膜腔相通形成支气管胸膜瘘。胸腔穿刺抽出了与脓胸相符的非伤寒沙门氏菌生长；患者接受了静脉注射头孢曲松治疗，并放置胸腔引流管引流脓胸，每天两次注入阿替普酶/脱氧核糖核酸酶，持续三天。胸部CT复查显示液气胸。患者随后接受了电视辅助胸腔镜下胸膜剥脱术。患者病情持续好转，胸部CT随访显示右侧局限性气胸改善，右支气管胸膜瘘和空洞性病变消失。我们描述了少数几例在播散性非伤寒沙门氏菌感染情况下发生支气管肺瘘和脓胸形成的病例。脓胸并发支气管肺瘘可能导致胸膜内纤维蛋白溶解治疗失败，患者最终除抗生素治疗外还需要进行胸膜剥脱术。虽然免疫功能低下患者可见非伤寒沙门氏菌菌血症，但非伤寒沙门氏菌感染的肠外表现如脓胸和支气管胸膜瘘并不常见。支气管胸膜瘘最常见于肺切除术后并发症。 本病例突出了免疫功能低下患者因播散性非伤寒沙门氏菌感染可能出现的不寻常肺部表现以及与这些并发症相关的复杂管理决策。
