Sameed Muhammad, Sullivan Scott, Marciniak Ellen T, Deepak Janaki
Internal Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA.
Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA.
BMJ Case Rep. 2019 Apr 16;12(4):e228741. doi: 10.1136/bcr-2018-228741.
A 24-year-old man with a history of HIV and large B cell lymphoma (currently in remission) presented with fever, dry cough and dizziness. His CD4+ count was undetectable, and the HIV viral load was 109 295 cop/mL. Physical examination revealed fever, hypotension and tachycardia with coarse breath sounds in the middle and lower chest zones bilaterally. Chest imaging showed diffuse abnormal micronodular and patchy infiltrates, without focal consolidation. A cavitary lesion was noted measuring 5×2 cm in axial dimensions within the left lower lobe and multiple small cystic lesions in the background. Bronchoalveolar lavage fluid culture grew The patient was empirically treated with vancomycin and piperacillin-tazobactam for multifocal pneumonia with concerns for sepsis and was started on combined antiretroviral therapy (cART) with abacavir/dolutegravir/lamivudine. Symptoms improved after day 3 of therapy, and the patient was discharged home on 2 weeks of moxifloxacin, in addition to the cART and appropriate chemoprophylaxis.
一名有人类免疫缺陷病毒（HIV）病史和大B细胞淋巴瘤（目前处于缓解期）的24岁男性，出现发热、干咳和头晕症状。其CD4+细胞计数无法检测到，HIV病毒载量为109295拷贝/毫升。体格检查发现发热、低血压和心动过速，双侧中下胸部区域呼吸音粗糙。胸部影像学显示弥漫性异常微小结节和斑片状浸润，无局灶性实变。在左下叶发现一个轴向尺寸为5×2厘米的空洞性病变，背景中有多个小囊性病变。支气管肺泡灌洗 fluid culture grew（此处原文有误，推测可能是“Bronchoalveolar lavage fluid culture grew bacteria”之类，暂按“支气管肺泡灌洗培养出……”理解）。鉴于患者有败血症风险，经验性地给予万古霉素和哌拉西林 - 他唑巴坦治疗多灶性肺炎，并开始使用阿巴卡韦/多替拉韦/拉米夫定进行联合抗逆转录病毒治疗（cART）。治疗第3天后症状改善，患者出院回家，除了接受cART和适当的化学预防外，还服用两周的莫西沙星。
