Kashiwaba Ryosuke, Oka Kohei, Yamamoto Natsumi, Sano Chiaki, Ohta Ryuichi
Family Medicine, International University of Health and Welfare Graduate School of Health Sciences, Tokyo, JPN.
Community Care, Unnan City Hospital, Unnan, JPN.
Cureus. 2024 Sep 24;16(9):e70121. doi: 10.7759/cureus.70121. eCollection 2024 Sep.
This case report describes an 85-year-old woman with a history of aspiration pneumonia who was admitted to a rural hospital with fever, vomiting, and decreased oxygenation. Initially diagnosed with aspiration pneumonia and acute pyelonephritis, she was treated with antibiotics. Despite this, her fever persisted, and subsequent imaging suggested aspiration pneumonitis or organizing pneumonia. Her condition improved following fasting and corticosteroid therapy. This case highlights the challenges in differentiating aspiration pneumonia from aspiration pneumonitis, as both conditions may present similarly but require different treatment approaches. Persistent fever despite broad-spectrum antibiotics prompted a change in treatment strategy, leading to the introduction of corticosteroids, which improved her symptoms. This case underscores the importance of considering aspiration pneumonitis in older patients with recurrent or persistent respiratory symptoms and fever, especially when dysphagia is present and antibiotic therapy is ineffective. Early intervention with corticosteroids, particularly when imaging findings are suggestive of organizing pneumonia, can prevent further deterioration. Accurate diagnosis and timely treatment adjustments are crucial in managing aspiration-related pulmonary conditions in elderly patients.
本病例报告描述了一名85岁有吸入性肺炎病史的女性，她因发热、呕吐和氧合下降入住一家乡村医院。最初诊断为吸入性肺炎和急性肾盂肾炎，给予抗生素治疗。尽管如此，她的发热仍持续存在，随后的影像学检查提示为吸入性肺炎或机化性肺炎。禁食和糖皮质激素治疗后她的病情有所改善。本病例突出了区分吸入性肺炎和吸入性肺炎的挑战，因为这两种情况可能表现相似，但需要不同的治疗方法。尽管使用了广谱抗生素但发热仍持续，促使治疗策略发生改变，从而引入了糖皮质激素，这改善了她的症状。本病例强调了在患有反复或持续呼吸道症状和发热的老年患者中考虑吸入性肺炎的重要性，特别是当存在吞咽困难且抗生素治疗无效时。早期使用糖皮质激素进行干预，尤其是当影像学表现提示机化性肺炎时，可以防止病情进一步恶化。准确的诊断和及时的治疗调整对于管理老年患者与吸入相关的肺部疾病至关重要。
