Chen Chih-Yu, Weng Yi-Ming, Chen Jih-Chang
Chang Gung Memorial Hospital and Chang Gung University College of Medicine Department of Emergency Medicine Linko Taiwan.
J Acute Med. 2017 Jun 1;7(2):75-78. doi: 10.6705/j.jacme.2017.0702.005.
Patients who survived recent paraquat intoxication might be treated with glucocorticoid andcyclophosphamide to avoid further lung fi brosis. Such patients might be susceptible to opportunistic infections. Pneumocystis pneumonia (PCP) is an important opportunistic lung infection in hematologic malignancy patients on chemotherapy. We report a patient who recently survived paraquat intoxication and presented with acute respiratory insuffi ciency post glucocorticoid and cyclosporine treatment. A fulminant clinical course, and a clear medical history of immunocompromised state draw physician's attention to the possible opportunistic lung infection. PCP infection was confi rmed by a PCP deoxyribonucleic acid test. The symptoms improved markedly after appropriate antibiotics treatment. This report suggests that clinicians should consider PCP infection in patients who develop secondary pneumonia after paraquat intoxication. PCP treatment as part of empirical antibiotics should be added, especially in such patients presented with rapidly progressive course.
近期百草枯中毒幸存的患者可使用糖皮质激素和环磷酰胺进行治疗,以避免进一步的肺纤维化。这类患者可能易患机会性感染。肺孢子菌肺炎(PCP)是接受化疗的血液系统恶性肿瘤患者重要的机会性肺部感染。我们报告一例近期百草枯中毒幸存的患者,在接受糖皮质激素和环孢素治疗后出现急性呼吸功能不全。其暴发性的临床病程以及明确的免疫功能低下病史引起了医生对可能的机会性肺部感染的关注。通过肺孢子菌脱氧核糖核酸检测确诊为PCP感染。经适当的抗生素治疗后症状明显改善。本报告提示,临床医生应考虑百草枯中毒后发生继发性肺炎的患者存在PCP感染。应添加PCP治疗作为经验性抗生素治疗的一部分,尤其是对于病程快速进展的此类患者。