Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, (100020), China.
BMC Infect Dis. 2019 Jul 29;19(1):671. doi: 10.1186/s12879-019-4306-7.
Organizing pneumonia (OP) is a rare complication of influenza infection that has substantial morbidity. We report the first case of OP associated with avian influenza H7N9 infection that had significant improvement with corticosteroid treatment.
A 35-year-old male admitted to intensive care unit because of respiratory failure. He was diagnosed as severe pneumonia caused by avian influenza H7N9 viral infection. After initial clinical improvement supported by extracorporeal membrane oxygenation (ECMO), the patient's condition worsened with persistent fever, refractory hypoxemia. Chest x-rays and computed tomographies showed areas of consolidation and ground glass opacification. Although OP was suspected and 1 mg/kg methylprednisolone was used, the patient's condition didn't improved considerably. An open lung biopsy was performed, and histopathological examination of the specimen was compatible with OP. The patient was treated with methylprednisolone 1.5 mg/kg for 5 days. ECMO was weaned on day 15, and he was discharged on day 71 with good lung recovery.
To the best of our knowledge, this was the first case of successful management of refractory severe respiratory failure caused by avian influenza H7N9 infection complicated with OP. Refractory hypoxia with clinical manifestation and radiological findings compatible with OP, a differential diagnosis should be considered among patients at the second or third week of influenza H7N9 infection, especially in patients with clinical condition deteriorated after the primary influenza pneumonia was controlled. And a steroid dose of methylprednisolone 1.5 mg/kg may be suggested for treatment of OP associated with avian influenza H7N9 infection.
机化性肺炎（OP）是流感感染的罕见并发症，具有较高的发病率。我们报告了首例与 H7N9 禽流感病毒感染相关的 OP，皮质类固醇治疗后病情显著改善。
一名 35 岁男性因呼吸衰竭入住重症监护病房。他被诊断为严重的 H7N9 禽流感病毒性肺炎。在体外膜氧合（ECMO）支持下，初始临床症状有所改善后，患者持续发热，出现难治性低氧血症，病情恶化。胸部 X 线和计算机断层扫描显示实变和磨玻璃影。尽管怀疑 OP 并使用了 1mg/kg 甲基泼尼松龙，但患者病情并未明显改善。进行了开胸肺活检，标本的组织病理学检查符合 OP。患者接受了 1.5mg/kg 甲基泼尼松龙治疗 5 天。第 15 天撤下 ECMO，第 71 天出院，肺部恢复良好。
据我们所知，这是首例成功治疗由 H7N9 禽流感感染引起的难治性严重呼吸衰竭合并 OP 的病例。对于在流感 H7N9 感染的第二或第三周出现临床表现和影像学检查符合 OP 的难治性低氧血症患者，应考虑进行鉴别诊断，特别是在原发性流感肺炎得到控制后临床病情恶化的患者。对于与 H7N9 禽流感感染相关的 OP，建议使用 1.5mg/kg 甲基泼尼松龙的皮质类固醇剂量进行治疗。
