Ma Hongye, Sun Jingjing, Zhang Lei, Liu Yu, Liu Hongjuan, Wu Xiaoling, Guo Litao
Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, People's Republic of China.
Department of Critical Care Medicine, The Fifth People's Hospital of ShaanXi, Xi'an, ShaanXi, People's Republic of China.
Infect Drug Resist. 2021 Nov 24;14:4903-4911. doi: 10.2147/IDR.S332992. eCollection 2021.
This study aimed to analyze the diagnosis and treatment process of patients with hematogenous disseminated pulmonary tuberculosis after treatment with in vitro fertilization-embryo transfer (IVF-ET). We retrospectively analyzed the clinical data, including imaging and etiological data, the use of antimicrobials, metagenomic next-generation sequencing (mNGS) results, and the treatment process, of a patient who underwent IVF-ET due to an obstruction in the fallopian tube; after the treatment, she developed a persistent fever with shortness of breath and suffered a spontaneous abortion. Due to the failure of other treatment modalities, fiber optic bronchoscopy was performed, and the alveolar lavage fluid was obtained for mNGS. Tests for and rifampicin resistance (Xpert MTB/RIF) showed positive and negative results, respectively. Subsequently, anti-tuberculosis treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol was administered. After the patient's condition improved, she was transferred to a specialized tuberculosis hospital for further treatment, where she died one month later from multiple organ failure. From this case, we conclude that clinicians should remain highly vigilant for pulmonary infection with in pregnant women, particularly in patients treated with IVF-ET, and check for its presence as soon as possible.
本研究旨在分析输卵管阻塞患者接受体外受精-胚胎移植(IVF-ET)治疗后血行播散型肺结核患者的诊断和治疗过程。我们回顾性分析了一名因输卵管阻塞接受IVF-ET治疗的患者的临床资料,包括影像学和病因学资料、抗菌药物使用情况、宏基因组下一代测序(mNGS)结果以及治疗过程;治疗后,她持续发热、呼吸急促,并发生了自然流产。由于其他治疗方式无效,遂进行了纤维支气管镜检查,并获取肺泡灌洗液进行mNGS检测。结核分枝杆菌及利福平耐药性检测(Xpert MTB/RIF)结果分别为阳性和阴性。随后,给予异烟肼、利福平、吡嗪酰胺和乙胺丁醇抗结核治疗。患者病情好转后,转至专科医院进一步治疗,1个月后因多器官功能衰竭死亡。从该病例中,我们得出结论,临床医生应高度警惕孕妇尤其是接受IVF-ET治疗的患者发生结核分枝杆菌肺部感染,并尽早进行排查。