Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
State Key Laboratory for Liver Research, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
BMC Infect Dis. 2019 Jan 18;19(1):66. doi: 10.1186/s12879-019-3723-y.
Pneumocystis pneumonia (PCP) is a common opportunistic infection caused by Pneumocystis jirovecii. Its incidence at 2 years or more after liver transplant (LT) is < 0.1%. PCP-related spontaneous pneumothorax and/or pneumomediastinum is rare in patients without the human immunodeficiency virus, with an incidence of 0.4-4%.
A 65-year-old woman who had split-graft deceased-donor LT for primary biliary cirrhosis developed fever, dyspnea and dry coughing at 25 months after transplant. Her immunosuppressants included tacrolimus, mycophenolate mofetil, and prednisolone. PCP infection was confirmed by molecular detection of Pneumocystis jirovecii,in bronchoalveolar lavage. On day-10 trimethoprim-sulphamethoxazole, her chest X-ray showed subcutaneous emphysema bilaterally, right pneumothorax and pneumomediastinum. Computed tomography of the thorax confirmed the presence of right pneumothorax, pneumomediastinum and subcutaneous emphysema. She was managed with 7-day right-sided chest drain and a 21-day course of trimethoprim-sulphamethoxazole before discharge.
Longer period of PCP prophylaxis should be considered in patients who have a higher risk compared to general LT patients. High index of clinical suspicion, prompt diagnosis and treatment with ongoing patient reassessment to detect and exclude rare, potentially fatal but treatable complications are essential, especially when clinical deterioration has developed.
肺囊虫肺炎（PCP）是由卡氏肺孢子虫引起的常见机会性感染。肝移植（LT）后 2 年或以上发生 PCP 的发病率<0.1%。在没有人类免疫缺陷病毒的情况下，PCP 相关的自发性气胸和/或纵隔气肿较为罕见，发病率为 0.4-4%。
一位 65 岁女性因原发性胆汁性肝硬化接受了尸体供体劈裂式 LT，在移植后 25 个月时出现发热、呼吸困难和干咳。她的免疫抑制剂包括他克莫司、霉酚酸酯和泼尼松龙。通过对支气管肺泡灌洗液中卡氏肺孢子虫的分子检测确认了 PCP 感染。第 10 天开始使用复方磺胺甲噁唑，她的胸部 X 线显示双侧皮下气肿、右侧气胸和纵隔气肿。胸部 CT 证实存在右侧气胸、纵隔气肿和皮下气肿。她接受了 7 天右侧胸腔引流和 21 天复方磺胺甲噁唑治疗，然后出院。
与一般 LT 患者相比，具有更高风险的患者应考虑更长时间的 PCP 预防。当出现临床恶化时，需要高度怀疑、及时诊断和治疗，并持续评估患者，以发现和排除罕见但潜在致命但可治疗的并发症，这一点至关重要。
