Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
Department of Respiratory and Critical Care Medicine, Deyang People's Hospital, Affiliated Hospital of Chengdu College of Medicine, Deyang, China.
Front Public Health. 2023 May 9;11:1145733. doi: 10.3389/fpubh.2023.1145733. eCollection 2023.
pneumonia, rhabdomyolysis, and acute kidney injury are called the triad, which is rare and associated with a poor outcome and even death. Early diagnosis and timely treatment are essential for these patients.
A 63-year-old man with cough, fever, and fatigue was initially misdiagnosed with common bacterial infection and given beta-lactam monotherapy but failed to respond to it. Conventional methods, including the first antibody test, sputum smear, and culture of sputum, blood, and bronchoalveolar lavage fluid (BALF) were negative. He was ultimately diagnosed with a severe infection of by metagenomics next-generation sequencing (mNGS). This patient, who had multisystem involvement and manifested with the rare triad of pneumonia, rhabdomyolysis, and acute kidney injury, finally improved after combined treatment with moxifloxacin, continuous renal replacement therapy, and liver protection therapy.
Our results showed the necessity of early diagnosis of pathogens in severe patients, especially in Legionnaires' disease, who manifested with the triad of pneumonia, rhabdomyolysis, and acute kidney injury. mNGS may be a useful tool for Legionnaires' disease in limited resource areas where urine antigen tests are not available.
肺炎、横纹肌溶解和急性肾损伤被称为三联征，较为罕见，与不良预后甚至死亡相关。这些患者的早期诊断和及时治疗至关重要。
一名 63 岁男性，以咳嗽、发热和乏力起病，最初被误诊为常见细菌感染，并给予β-内酰胺类单药治疗，但无效。包括首次抗体检测、痰涂片和痰、血及支气管肺泡灌洗液（BALF）培养在内的常规方法均为阴性。最终通过宏基因组下一代测序（mNGS）诊断为严重感染。该患者多系统受累，表现为罕见的肺炎、横纹肌溶解和急性肾损伤三联征，经过莫西沙星联合连续性肾脏替代治疗和保肝治疗后病情好转。
我们的结果表明，对于重症患者，特别是表现为肺炎、横纹肌溶解和急性肾损伤三联征的军团病患者，早期诊断病原体非常必要。在无法进行尿抗原检测的资源有限地区，mNGS 可能是诊断军团病的一种有用工具。
