Department of Clinical Pharmacy, Bethune International Peace Hospital, Shijiazhuang, Hebei, China.
Department of Neurology, Bethune International Peace Hospital, Shijiazhuang, Hebei, China.
Medicine (Baltimore). 2024 Jun 14;103(24):e38544. doi: 10.1097/MD.0000000000038544.
Chronic inflammatory demyelinating polyneuropathy (CIDP) is an immune-mediated motor sensory peripheral neuropathy that is rare in clinical practice. This treatment method aims to suppress potential immunopathology. Nocardiosis is a rare, destructive, opportunistic disease. We report a case of failed treatment of CIDP combined with pulmonary nocardiosis, and for the first time, we link these 2 diseases together.
A 65-year-old man developed symmetrical limb weakness. Four months later, he was diagnosed with CIDP and started receiving glucocorticoid (GC) treatment. The disease progressed slowly and was treated with mycophenolate mofetil (MMF) in combination. He did not follow the doctor requirements for monthly follow-up visits, and the preventive medication for sulfamethoxazole/trimethoprim was not strictly implemented. Two months after the combination therapy, the patient developed fever, coughing and sputum production, as well as fatigue and poor appetite. Based on imaging and etiological results, he was diagnosed with pulmonary nocardiosis.
Chronic inflammatory demyelinating polyneuropathy, pulmonary nocardiosis.
After treatment with antibiotics, the patient lung infection temporarily improved. However, the patient CIDP condition progressed, limb weakness worsened, respiratory muscle involvement occurred, and intravenous immunoglobulin (IVIG) was administered. However, there was no significant improvement in the condition, and the patient died.
In this report, we present a case of a patient with CIDP and pulmonary nocardiosis. It is worth noting that in order to avoid the progression and recurrence of CIDP, we did not stop using related therapeutic drugs during the treatment process, the patient had repeatedly refused to use IVIG. Despite this, the patient condition worsened when lung inflammation improved, leading to persistent respiratory failure and ultimately death. Treatment contradictions, medication issues, and patient compliance issues reflected in this case are worth considering.
For patients with CIDP receiving immunosuppressive therapy, attention should be paid to the occurrence and severity of Nocardia infection. Therefore, early detection and treatment are necessary. We need to pay attention to the compliance of patients with prophylactic use of antibiotics, strengthen the follow-up, and urge them to return to their appointments on time.
慢性炎症性脱髓鞘性多发性神经病（CIDP）是一种罕见的临床免疫介导的运动感觉周围神经病。这种治疗方法旨在抑制潜在的免疫病理学。奴卡氏菌病是一种罕见的、破坏性的、机会性疾病。我们报告了一例 CIDP 合并肺奴卡菌病治疗失败的病例，并首次将这两种疾病联系起来。
一名 65 岁男性出现对称性肢体无力。4 个月后，他被诊断为 CIDP 并开始接受糖皮质激素（GC）治疗。疾病进展缓慢，并用吗替麦考酚酯（MMF）联合治疗。他没有按照医生的要求每月进行随访，也没有严格执行磺胺甲噁唑/甲氧苄啶的预防用药。联合治疗后 2 个月，患者出现发热、咳嗽、咳痰，以及乏力、食欲差。根据影像学和病因学结果，他被诊断为肺奴卡菌病。
慢性炎症性脱髓鞘性多发性神经病，肺奴卡菌病。
患者经抗生素治疗后肺部感染暂时好转。然而，患者的 CIDP 病情进展，肢体无力加重，出现呼吸肌受累，给予静脉注射免疫球蛋白（IVIG）治疗，但病情无明显改善，最终死亡。
在本报告中，我们介绍了一例 CIDP 合并肺奴卡菌病的病例。值得注意的是，为了避免 CIDP 的进展和复发，我们在治疗过程中没有停止使用相关治疗药物，患者多次拒绝使用 IVIG。尽管如此，当肺部炎症改善时，患者病情恶化，导致持续性呼吸衰竭，最终死亡。该病例反映出的治疗矛盾、用药问题和患者依从性问题值得思考。
对于接受免疫抑制治疗的 CIDP 患者，应注意奴卡菌感染的发生和严重程度。因此，早期发现和治疗是必要的。我们需要注意预防性使用抗生素的患者的依从性，加强随访，并督促他们按时复诊。
