Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
BMJ Case Rep. 2022 Apr 29;15(4):e248273. doi: 10.1136/bcr-2021-248273.
A transgender man in his late teens presented with signs of multisystem disease, including hepatitis, mucositis and bone marrow suppression. He later developed dyspnoea, leucocytosis and bilateral pulmonary infiltrates on chest radiograph. He was treated for community-acquired pneumonia. After several days of treatment, he developed hypoxaemic respiratory failure due to bronchoscopy-confirmed diffuse alveolar haemorrhage (DAH). The differential diagnosis and workup were extensive, and he was ultimately treated with intravenous steroids and five sessions of plasmapheresis for a presumed autoimmune aetiology. Investigations were remarkable only for elevated IgM and IgG to (MP). This case represents a rare presentation of multisystem disease secondary to MP in adults. Clinicians should consider infection in cases of multisystem disease and observe for DAH even after initiation of appropriate therapy.
一位十几岁的跨性别男性出现了多种系统疾病的症状，包括肝炎、黏膜炎和骨髓抑制。后来他出现了呼吸困难、白细胞增多和胸部 X 光片上的双侧肺浸润。他被诊断为社区获得性肺炎。经过几天的治疗，他因支气管镜检查证实的弥漫性肺泡出血（DAH）而发生低氧性呼吸衰竭。鉴别诊断和检查范围广泛，最终他因疑似自身免疫病因接受了静脉类固醇和五次血浆置换治疗。检查结果仅显示 IgM 和 IgG 升高到（MP）。该病例代表了成人继发于 MP 的多系统疾病的罕见表现。临床医生应考虑到多系统疾病患者感染的可能性，即使在开始适当治疗后也要观察 DAH 的发生。
