Deng Xiao-Lu, Zhao Chun-Guang, Ma Xin-Hua, Wang Xia
Department of Pediatrics, Xiangya Hospital, Central South University, Changsha 410008, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2020 Dec;22(12):1326-1330. doi: 10.7499/j.issn.1008-8830.2008143.
A boy, aged 6 years and 11 months, was admitted due to nephrotic syndrome for 2 years, cough for 1 month, and shortness of breath for 15 days. The boy had a history of treatment with hormone and immunosuppressant. Chest CT after the onset of cough and shortness of breath showed diffuse ground-glass opacities in both lungs. Serum (1, 3)-beta-D glucan was tested positive, and the nucleic acid of cytomegalovirus was detected in respiratory secretions. After the anti-fungal and anti-viral treatment, the child improved temporarily but worsened again within a short period of time. was identified by Gomori's methenamine silver staining in bronchoalveolar lavage fluid. The child was diagnosed with severe pneumonia ( and cytomegalovirus infection), acute respiratory distress syndrome, and nephrotic syndrome. After anti-infective therapy with sulfamethoxazole/trimethoprim and ganciclovir and respiratory support, the child still experienced progressive aggravation of dyspnea and tension pneumothorax, and extracorporeal membrane oxygenation (ECMO) was given on day 13 of invasive ventilation. Anti-infective therapy with sulfamethoxazole/trimethoprim, ganciclovir, and linezolid, anticoagulation therapy, sedation therapy, nutrition, and comprehensive management of the respiratory tract were given during ECMO. The child was successfully weaned from ECMO after 72 days, resulting in a length of hospital stay of 134 days. The child was followed up for 6 months after discharge, and there was a significant improvement on lung CT, without organ dysfunction. It is concluded that pneumonia is a potential lifethreatening infection for children with low immunity, and that ECMO can effectively improve the prognosis of children with severe respiratory distress syndrome.
一名6岁11个月大的男孩因肾病综合征2年、咳嗽1个月、气短15天入院。该男孩有激素和免疫抑制剂治疗史。咳嗽和气促发作后胸部CT显示双肺弥漫性磨玻璃影。血清（1,3）-β-D葡聚糖检测呈阳性，呼吸道分泌物中检测到巨细胞病毒核酸。抗真菌和抗病毒治疗后，患儿暂时好转，但短期内再次恶化。支气管肺泡灌洗液经Gomori六胺银染色确诊。患儿被诊断为重症肺炎（及巨细胞病毒感染）、急性呼吸窘迫综合征和肾病综合征。在使用复方磺胺甲恶唑、更昔洛韦抗感染治疗及呼吸支持后，患儿仍出现呼吸困难进行性加重及张力性气胸，有创通气第13天给予体外膜肺氧合（ECMO）治疗。ECMO治疗期间给予复方磺胺甲恶唑、更昔洛韦、利奈唑胺抗感染治疗、抗凝治疗、镇静治疗、营养支持及呼吸道综合管理。患儿72天后成功撤离ECMO，住院134天。患儿出院后随访6个月，肺部CT有明显改善，无器官功能障碍。结论是，肺炎是低免疫儿童潜在的危及生命的感染，ECMO可有效改善重症呼吸窘迫综合征患儿的预后。
