Rogers B H, Donowitz G R, Walker G K, Harding S A, Sande M A
N Engl J Med. 1979 Nov 1;301(18):959-61. doi: 10.1056/NEJM197911013011802.
Five patients had opportunistic pulmonary infection caused by acid-fast bacilli, unusual clinical presentations and a unique pathological picture. Clinically, these cases mimicked septic pulmonary emboli or bacterial pneumonia. The infection was temporally related to high-dose corticosteroid therapy, given for renal-transplant rejection in four patients and for therapy of lymphocytic lymphoma in one. Histologic sections of lung-biopsy or autopsy material showed an acute suppurative pneumonia with dense alveolar infiltration by neutrophils, without granuloma formation or caseous necrosis. Predominantly intracellular acid-fast bacilli were present. The organism failed to grow in culture on routine bacterial, fungal and mycobacterial mediums. This unusual and possibly new acid-fast organism is a probable cause of suppurative pneumonia in impaired hosts receiving corticosteroid therapy.
5例患者发生了由抗酸杆菌引起的机会性肺部感染，临床表现不寻常，病理表现独特。临床上，这些病例类似脓毒性肺栓塞或细菌性肺炎。感染在时间上与大剂量皮质类固醇治疗有关，4例患者因肾移植排斥反应接受该治疗，1例因淋巴细胞淋巴瘤接受治疗。肺活检或尸检材料的组织学切片显示为急性化脓性肺炎，有密集的中性粒细胞肺泡浸润，无肉芽肿形成或干酪样坏死。主要为细胞内抗酸杆菌。该病原体在常规细菌、真菌和分枝杆菌培养基上均未培养生长。这种不寻常且可能是新的抗酸菌可能是接受皮质类固醇治疗的免疫受损宿主发生化脓性肺炎的原因。
