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非寻常嫌疑菌:免疫功能正常患者中的铜绿假单胞菌与空洞性肺病变

The Uncommon Suspect: Pseudomonas aeruginosa and Cavitary Lung Lesions in an Immunocompetent Patient.

作者信息

Allena Nishant, Arshad Mahnoor, Athar Zoraize Moeez, Bojja Srikaran, Singhal Ravish

机构信息

Pulmonary Medicine, BronxCare Health System, New York, USA.

Internal Medicine, BronxCare Health System, New York, USA.

出版信息

Cureus. 2024 Aug 3;16(8):e66075. doi: 10.7759/cureus.66075. eCollection 2024 Aug.

DOI:10.7759/cureus.66075
PMID:39224733
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11368137/
Abstract

Cavitary lung lesions pose a formidable diagnostic challenge due to their multifaceted etiologies. While tuberculosis and other prevalent pathogens typically dominate discussions, instances of community-acquired () pneumonia leading to cavitation in immunocompetent individuals remain exceptionally rare. Herein, we present a compelling case of such pneumonia in a 61-year-old man with a past medical history of hypertension and coronary artery disease who presented with cough, chest pain, and subjective fever. Chest imaging revealed cavitary lung lesions, which is atypical for community-acquired pneumonia (CAP). Initial workup excluded common CAP pathogens, following which bronchoscopy with bronchoalveolar lavage (BAL) definitively diagnosed , prompting targeted antibiotic therapy. Treatment led to clinical and radiographic improvement. rarely causes CAP, especially in immunocompetent patients, and cavitary lesions further complicate diagnosis. This case highlights the importance of considering in CAP with unusual features and emphasizes the utility of bronchoscopy with BAL for diagnosis and guiding management.

摘要

空洞性肺病变因其病因的多面性而带来了巨大的诊断挑战。虽然结核病和其他常见病原体通常是讨论的重点,但在免疫功能正常的个体中,社区获得性()肺炎导致空洞形成的病例仍然极为罕见。在此,我们报告一例令人关注的此类肺炎病例,患者为一名61岁男性,有高血压和冠状动脉疾病病史,表现为咳嗽、胸痛和主观发热。胸部影像学显示有空洞性肺病变,这对于社区获得性肺炎(CAP)来说并不典型。初步检查排除了常见的CAP病原体,随后通过支气管镜检查及支气管肺泡灌洗(BAL)明确诊断为,从而进行了针对性的抗生素治疗。治疗使临床和影像学表现得到改善。很少引起CAP,尤其是在免疫功能正常的患者中,而空洞性病变进一步使诊断复杂化。该病例强调了在具有不寻常特征的CAP中考虑的重要性,并强调了支气管镜检查及BAL在诊断和指导治疗方面的作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9998/11368137/7952337e5f1d/cureus-0016-00000066075-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9998/11368137/5f8ecf7c5863/cureus-0016-00000066075-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9998/11368137/9e54032c9888/cureus-0016-00000066075-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9998/11368137/d42fd2242f47/cureus-0016-00000066075-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9998/11368137/29d66224540b/cureus-0016-00000066075-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9998/11368137/7952337e5f1d/cureus-0016-00000066075-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9998/11368137/5f8ecf7c5863/cureus-0016-00000066075-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9998/11368137/9e54032c9888/cureus-0016-00000066075-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9998/11368137/d42fd2242f47/cureus-0016-00000066075-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9998/11368137/29d66224540b/cureus-0016-00000066075-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9998/11368137/7952337e5f1d/cureus-0016-00000066075-i05.jpg

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