Clin Lab. 2024 Aug 1;70(8). doi: 10.7754/Clin.Lab.2024.240232.
In August 2023, our hospital confirmed a case of IgA nephropathy complicated with pulmonary infection by Mycobacterium abscess. The patient sought medical attention at our hospital due to "gross hematuria for 10 years, recurrence for 10 days, coughing and sputum production". The patient had pulmonary tuberculosis 15 years ago and had been cured. He had bronchiectasis for 10 years.
Chest CT, fiberoptic bronchoscopy examination, urine routine (urine analysis + sediment quantification), urine trace protein measurement//urine creatinine (random urine), urine protein quantification (24-hour urine), antinuclear antibody measurement (ANA), sputum culture, alveolar lavage fluid bacterial culture, alveolar lavage fluid acid fast staining, and alveolar lavage fluid mNGS.
Chest CT: Cystic dilation of bronchi in both lungs, mainly in the lower lungs, with visible phlegm clots inside. Fibrobronchoscopy: A large amount of white foam like secretions can be seen in the lumens of the middle lobe of the right lung and the lower lobes of both lungs. Urinary routine (urine analysis + sediment quantification): protein+↑, occult blood+++. Urine Microprotein Determination//Urine Creatinine (Random Urine): Microalbumin 156.00 mg/L, Urine mALB/Urine Creatinine 132.73 mg/g; Quantitative determination of urine protein (24-hour urine): total protein 0.93 g/24-hour urine; Antinuclear antibody assay (ANA): weakly positive; Sputum bacterial culture: negative; Bacterial culture of bronchoalveolar lavage fluid: Mycobacterium abscess++, NGS in bronchoalveolar lavage fluid: Mycobacterium abscess. Clinical treatment plan: 0.25 g of azithromycin qd po+ 0.4 g of amikacin sulfate qd ivgtt+ 1 g cefmetazole sodium q12hours ivgtt. After 10 days of treatment, the patient improved and was discharged.
This article reports a case of IgA nephropathy complicated with pulmonary abscess mycobacterial infection. Mycobacterium abscess was quickly and accurately identified by mNGS. Reasonable treatment measures were adopted clinically. The patient improved and was discharged. This study has important reference significance for the clinical diagnosis and treatment of Mycobacterium abscess infection. In addition, mNGS, as a novel detection method, has considerable prospects for rapid diagnosis of pathogens.
2023 年 8 月，我院确诊 1 例 IgA 肾病合并肺脓肿分枝杆菌感染患者。该患者因“血尿 10 年，再发 10 天，咳嗽、咳痰”就诊我院。患者 15 年前患肺结核，已治愈，支气管扩张 10 年。
行胸部 CT、纤维支气管镜检查，尿沉渣（尿分析+定量）、尿微量蛋白测定//尿肌酐（随机尿）、尿蛋白定量（24 小时尿）、抗核抗体测定（ANA）、痰培养、肺泡灌洗液细菌培养、肺泡灌洗液抗酸染色、肺泡灌洗液宏基因组二代测序（mNGS）。
胸部 CT：双肺支气管囊状扩张，以双下肺为主，内可见脓性痰栓。纤维支气管镜：右肺中叶及双肺下叶各级支气管腔内可见大量白色泡沫样分泌物。尿沉渣（尿分析+定量）：蛋白+↑，隐血+++。尿微量蛋白测定//尿肌酐（随机尿）：微量白蛋白 156.00mg/L，尿 mALB/尿肌酐 132.73mg/g；尿蛋白定量（24 小时尿）：总蛋白 0.93g/24 小时尿；抗核抗体测定（ANA）：弱阳性；痰细菌培养：阴性；肺泡灌洗液细菌培养：脓肿分枝杆菌++，肺泡灌洗液 mNGS：脓肿分枝杆菌。临床治疗方案：阿奇霉素 0.25gqdpo+硫酸阿米卡星 0.4gqdivgtt+头孢美唑钠 1gq12hivgtt。治疗 10 天后，患者好转出院。
本文报道了 1 例 IgA 肾病合并肺脓肿分枝杆菌感染病例，mNGS 快速准确鉴定出脓肿分枝杆菌，临床采取了合理的治疗措施，患者好转出院。该研究对脓肿分枝杆菌感染的临床诊断与治疗具有重要的参考意义。另外，mNGS 作为一种新型的病原体检测方法，对于病原体的快速诊断具有相当大的应用前景。
