Miyamoto Kai, Uchida Yoshihito, Tsuji Shohei, Inao Mie, Sugawara Kayoko, Nakao Masamitsu, Nakayama Nobuaki, Imai Yukinori, Mizuno Suguru, Mochida Satoshi
Clinical Training Center, Saitama Medical University Hospital, Saitama, Japan.
Department of Gastroenterology and Hepatology, Faculty of Medicine, Saitama Medical University, Iruma-Gun, 38 Morohongo, Moroyama-cho, Saitama, 350-0495, Japan.
Clin J Gastroenterol. 2025 Jun 3. doi: 10.1007/s12328-025-02149-4.
A 55-year-old man with a 13-year history of alcohol-related cirrhosis was admitted for the management of refractory ascites. On day 4 of hospitalization, he developed dyspnea, and chest computed tomography (CT) revealed ground-glass opacities and reticular shadows in both lungs, predominantly in the left upper lobe. Aspiration pneumonia was initially suspected, and cefmetazole was administered. However, by day 11, his respiratory status deteriorated, with SpO₂ dropping to 90%. A follow-up chest CT showed progression of bilateral ground-glass opacities. Further testing revealed an elevated β-D-glucan level of 142.5 pg/mL and KL-6 level of 1.770 U/mL, along with a positive sputum PCR for Pneumocystis jirovecii, confirming a diagnosis of pneumocystis pneumonia (PCP). As human immunodeficiency virus (HIV) testing was negative, he was diagnosed with non-HIV PCP. Despite treatment with trimethoprim-sulfamethoxazole and hydrocortisone, he died on day 17. Notably, his peripheral lymphocyte count was below 500/μL before admission, suggesting that cirrhosis-associated immune dysfunction (CAID) contributed to his susceptibility to non-HIV PCP. This case highlights the importance of monitoring peripheral lymphocyte counts in patients with advanced liver cirrhosis, as CAID may increase the risk of life-threatening infections such as non-HIV PCP.
一名有13年酒精性肝硬化病史的55岁男性因难治性腹水入院治疗。住院第4天，他出现呼吸困难，胸部计算机断层扫描（CT）显示双肺磨玻璃影和网状阴影，主要位于左上叶。最初怀疑是吸入性肺炎，给予头孢美唑治疗。然而，到第11天，他的呼吸状况恶化，血氧饱和度降至90%。胸部CT随访显示双侧磨玻璃影进展。进一步检查发现β-D-葡聚糖水平升高至142.5 pg/mL，KL-6水平为1.770 U/mL，痰中肺孢子菌PCR检测呈阳性，确诊为肺孢子菌肺炎（PCP）。由于人类免疫缺陷病毒（HIV）检测为阴性，他被诊断为非HIV相关PCP。尽管接受了甲氧苄啶-磺胺甲恶唑和氢化可的松治疗，他还是在第17天死亡。值得注意的是，他入院前外周淋巴细胞计数低于500/μL，提示肝硬化相关免疫功能障碍（CAID）导致他易患非HIV相关PCP。该病例强调了监测晚期肝硬化患者外周淋巴细胞计数的重要性，因为CAID可能增加非HIV相关PCP等危及生命感染的风险。
