Sullivan Abigayle, Lanham Theresa, Krol Ronald, Zachariah Shilla
Department of Internal Medicine, Reading Hospital-Tower Health System, West Reading, PA, USA.
Department of Pulmonary and Critical Care, Reading Hospital-Tower Health System, West Reading, PA, USA.
Case Rep Infect Dis. 2020 Jul 12;2020:8532780. doi: 10.1155/2020/8532780. eCollection 2020.
We describe a rare case of pneumonia (PCP) in a heterosexual man with a pertinent medical history of well-controlled human immunodeficiency virus (HIV) on highly active antiretroviral therapy (HAART) and PCP prophylaxis with atovaquone. The patient presented with recurrent shortness of breath, worsening malaise, and fever, following treatment for hypersensitivity pneumonitis one month prior, including a twenty-four-day course of 40 milligrams daily glucocorticoid with taper. However, transbronchial biopsies, lavage, and cytology from prior admission were inconclusive. The patient refused video-assisted thoracic surgery (VATS) at that time. Upon readmission, bronchoscopy with right VATS and lung biopsy were performed. Grocott's methenamine silver stain of right lung biopsy was positive for . This case is a rare example of PCP in a patient with a normal CD4 count (>487 cells/L) and a low viral load (<20 copies/mL) despite PCP prophylactic antibiotics in the setting of recent iatrogenic immunosuppression.
我们描述了一例罕见的卡氏肺孢子虫肺炎（PCP）病例，患者为一名异性恋男性，有相关病史，其人类免疫缺陷病毒（HIV）病情通过高效抗逆转录病毒疗法（HAART）得到良好控制，并使用阿托伐醌进行PCP预防。该患者在一个月前因过敏性肺炎接受治疗后出现反复气短、不适加重和发热，治疗包括每日40毫克糖皮质激素持续24天的疗程并逐渐减量。然而，之前住院时的经支气管活检、灌洗和细胞学检查结果不明确。患者当时拒绝了电视辅助胸腔镜手术（VATS）。再次入院时，进行了右VATS支气管镜检查和肺活检。右肺活检的Grocott六胺银染色显示阳性。尽管在近期医源性免疫抑制的情况下使用了PCP预防性抗生素，但该病例是CD4计数正常（>487个细胞/微升）且病毒载量低（<20拷贝/毫升）的患者发生PCP的罕见例子。
