Jin Wenting, Miao Qing, Wang Mengran, Zhang Yao, Ma Yuyan, Huang Yingnan, Wu Honglong, Lin Yang, Hu Bijie, Pan Jue
Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Binhai Genomics Institute, Tianjin Translational Genomics Center, BGI-Tianjin, BGI-Shenzhen, Tianjin 300308, China.
Ann Transl Med. 2020 Mar;8(5):247. doi: 10.21037/atm.2020.01.123.
A 50-year-old woman presented with right back pain, low fever, leukocytosis, a high level of C-reactive protein and a high erythrocyte sedimentation rate. Abdominal magnetic resonance imaging (MRI) revealed a hypodense lesion in the right suprarenal region, while PET/CT showed mildly increased metabolic activity. A CT-guided percutaneous puncture was performed, and foul-smelling thick pus was removed, which indicated an anaerobic infection. A smear of the pus showed both gram-positive and gram-negative microorganisms. Traditional culture only detected and . While surprisingly, metagenomic next-generation sequencing (mNGS) of both the pus and blood showed high reads of multiple pathogens, including anaerobes and the three culture-positive pathogens. Thus, adrenal gland abscess was confirmed, and a combination therapy of catheter drainage and effective antimicrobial treatment was started. Six days later, the patient had clinically improved and mNGS showed dramatically decreased reads of all pathogens. A follow-up lab examination of inflammatory biomarkers was normal, and the adrenal mass was reduced radiographically.
一名50岁女性出现右背部疼痛、低热、白细胞增多、C反应蛋白水平升高和红细胞沉降率升高。腹部磁共振成像（MRI）显示右肾上腺区域有一个低密度病变，而正电子发射断层扫描/计算机断层扫描（PET/CT）显示代谢活性轻度增加。进行了CT引导下经皮穿刺，抽出了有恶臭的浓稠脓液，提示存在厌氧菌感染。脓液涂片显示有革兰氏阳性和革兰氏阴性微生物。传统培养仅检测到 和 。然而，令人惊讶的是，脓液和血液的宏基因组下一代测序（mNGS）显示多种病原体的读数很高，包括厌氧菌和三种培养阳性的病原体。因此，确诊为肾上腺脓肿，并开始了导管引流和有效的抗菌治疗联合治疗。六天后，患者临床症状改善，mNGS显示所有病原体的读数显著下降。炎症生物标志物的随访实验室检查正常，肾上腺肿块在影像学上缩小。
