Naiditch Hiam, Strollo Hilary, Gipson Vanessa, Sica Gabriel, Joshi Urvashi, Ito Sawa, Rossetti James, Hensley Matthew
Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Chest. 2025 Feb;167(2):e47-e51. doi: 10.1016/j.chest.2024.08.011.
A 40-year-old man with chronic myeloid leukemia presented to the hospital with recurrent dyspnea and hypoxemic respiratory failure. He presented from his outpatient transplant infectious diseases appointment with dyspnea, cough, worsening hypoxemia, acute kidney injury, and somnolence after discharge from the hospital 2 weeks prior with a similar presentation. During the previous hospital stay, he underwent bronchoscopy and alveolar lavage with negative infectious workup. He was prescribed caspofungin, amphotericin, and continued posaconazole for prior probable invasive fungal infection (elevated blood BD-glucan and pulmonary nodules). Antibiotics included previous meropenem for esophageal nocardiosis, cefepime and azithromycin during admission, and now ceftriaxone for nocardiosis in the outpatient setting for convenience of home infusion. He was prescribed diuretics for presumed volume overload. Despite home diuretics, antimicrobials, and supplemental oxygen, he re-presented with worsening symptoms.
一名40岁慢性髓系白血病男性患者因反复出现呼吸困难和低氧性呼吸衰竭入院。他在门诊移植感染病门诊就诊时出现呼吸困难、咳嗽、低氧血症加重、急性肾损伤，且在2周前因类似症状出院后出现嗜睡。在前次住院期间，他接受了支气管镜检查和肺泡灌洗，感染相关检查结果为阴性。他因之前可能的侵袭性真菌感染（血液BD-葡聚糖升高和肺部结节）而被给予卡泊芬净、两性霉素，并继续使用泊沙康唑。抗生素方面，之前因食管诺卡菌病使用过美罗培南，入院时使用头孢吡肟和阿奇霉素，现在为方便家庭输液在门诊因诺卡菌病使用头孢曲松。他因推测存在容量超负荷而被给予利尿剂。尽管在家中使用了利尿剂、抗菌药物和补充氧气，但他仍因症状恶化再次就诊。
