Gomes Felisbela, La Feria Pedro, Costa Catarina, Texeira Helena
Unidade Funcional de Medicina 2.1, Hospital de Santo António dos Capuchos, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
Eur J Case Rep Intern Med. 2019 Jan 3;6(1):000997. doi: 10.12890/2019_000997. eCollection 2019.
Immunosuppressed patients are at greater risk of unusual infections. The authors present the case of a woman with giant-cell arteritis, on oral steroids, who developed cavitating pneumonia due to co-infection with and . Reports of such co-infection are rare in the literature. This case highlights the importance of considering rare pathogens in immunosuppressed patients who present with non-specific symptoms, as well as the impact of such pathogens on clinical management. Another important issue is the need for prophylaxis against spp. in immunocompromised patients.
In patients with vasculitis on systemic corticosteroid therapy or other immunosuppressive treatment, suspicion of uncommon infection should increase in parallel with the cumulative dose of these drugs.Obtaining an accurate diagnosis and early treatment is essential, but can be very challenging.Regular prophylactic therapy should be considered. However, more research is needed to determine whether higher doses of TMP/SMX would provide adequate coverage.
免疫抑制患者发生不寻常感染的风险更高。作者报告了一例患有巨细胞动脉炎且正在口服类固醇的女性病例,该患者因合并感染[具体病原体1]和[具体病原体2]而发展为空洞性肺炎。文献中关于这种合并感染的报道很少。该病例强调了在出现非特异性症状的免疫抑制患者中考虑罕见病原体的重要性,以及此类病原体对临床管理的影响。另一个重要问题是免疫功能低下患者预防[具体病原体种类]感染的必要性。
对于接受全身糖皮质激素治疗或其他免疫抑制治疗的血管炎患者,对不常见感染的怀疑应与这些药物的累积剂量同步增加。获得准确诊断和早期治疗至关重要,但可能极具挑战性。应考虑进行常规预防性治疗。然而,需要更多研究来确定更高剂量的复方新诺明是否能提供足够的覆盖范围。