Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
Medicine (Baltimore). 2023 Feb 3;102(5):e32290. doi: 10.1097/MD.0000000000032290.
Pneumocystis pneumonia (PCP) is an opportunistic infection of patients with congenital or acquired immunodeficiency. It is most frequently occurred in human immunodeficiency virus (HIV) infection, organ transplantation, leukemia, and immunosuppressive therapy. Here we describe the rare case of PCP in a non-HIV-infected diabetic patient and find possible reasons for the association through a literature review.
A 65-years-old male was admitted to our hospital due to a 10-year history of abnormal blood glucose levels and edema of both lower extremities for half a month. However, the patient developed a high fever and progressive dyspnea during hospitalization.
The patient had elevated blood sugar levels, a low white blood cell count within normal limits, and severe lymphopenia. His blood G test and lactate dehydrogenase levels increased significantly. Multiple sputa and bronchoalveolar lavage fluid specimens for Pneumocystis jirovecii (PJ) nucleic acid detection were positive. Chest computed tomography scan demonstrated hazy patchy shadows in the lungs suspected to be pulmonary infections. No tumor, transplantation, or an autoimmune disease was found in the examinations. The patient was diagnosed with PCP finally.
A combination of oral trimethoprim-sulfamethoxazole and intravenous caspofungin was administered immediately against PJ. The patient was also treated with noninvasive ventilator-assisted ventilation, subcutaneous insulin, and hemodialysis therapy.
The patient was discharged home finally with a fair general condition and was followed up without respiratory symptoms.
The compromised immunity in HIV-negative patients with diabetes may be related to lymphocyte decrease and dysfunction, which may cause diabetic patients prone to PJ. Although PCP is rare in diabetes, it should be paid attention to the high rate of misdiagnosis and missed diagnosis.
肺囊虫肺炎（PCP）是先天性或获得性免疫缺陷患者的机会性感染。它最常发生于人类免疫缺陷病毒（HIV）感染、器官移植、白血病和免疫抑制治疗。在此，我们描述了一例非 HIV 感染的糖尿病患者中罕见的 PCP 病例，并通过文献复习发现了可能的关联原因。
一名 65 岁男性，因 10 年血糖异常和双下肢水肿半月余入院。然而，患者在住院期间出现高热和进行性呼吸困难。
患者血糖升高，白细胞计数正常范围内偏低，严重淋巴细胞减少。血 G 试验和乳酸脱氢酶水平显著升高。多次痰和支气管肺泡灌洗液标本检测肺孢子菌（PJ）核酸均为阳性。胸部计算机断层扫描显示肺部呈模糊斑片状阴影，疑似肺部感染。检查未发现肿瘤、移植或自身免疫性疾病。最终患者被诊断为 PCP。
立即给予口服复方磺胺甲噁唑和静脉用卡泊芬净联合治疗 PJ。患者还接受了无创呼吸机辅助通气、皮下胰岛素和血液透析治疗。
患者最终情况良好出院，并进行了随访，无呼吸道症状。
糖尿病患者免疫功能受损，可能与淋巴细胞减少和功能障碍有关，这可能导致糖尿病患者易患 PJ。尽管 PCP 在糖尿病中罕见，但应注意其误诊和漏诊率较高。
