Chen Jingrou, Fang Jingchun, Sun Li, Zhang Zongjun, Ma Qinghua, Wu Jiahao, Chen Yili, Liao Kang, Long Tiandi, Xu Hongxu
Department of Laboratory Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Laboratory Medicine, Nansha Division, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Virulence. 2025 Dec;16(1):2545570. doi: 10.1080/21505594.2025.2545570. Epub 2025 Aug 28.
Myasthenia gravis (MG), a rare autoimmune disorder with poor prognosis, especially when complicated by opportunistic infections, which pose significant risks in clinical practice. We aimed to analyse a clinical case of a middle-aged male patient with MG, who developed severe lower gastrointestinal bleeding and multiple opportunistic infections post-immunosuppressive therapy. This case report is based on comprehensive clinical evaluations, including colonoscopy, histopathological examination, bronchoscopy, bronchoalveolar lavage (BAL), and metagenomic next-generation sequencing (mNGS). The patient exhibited persistent ptosis and pulmonary infection, and was treated with Meropenem 12 mg once daily (qd), Tacrolimus 2 mg qd, and Bromhexine 60 mg three times daily (tid). Due to ongoing lower gastrointestinal bleeding, surgery was performed. Colonoscopy revealed multiple ulcers, with histopathology confirming Cytomegalovirus (CMV) and Histoplasmosis infections. Bronchoalveolar lavage fluid (BALF) identified infections with Aspergillus fumigatus, Talaromyces, and Stenotrophomonas maltophilia. mNGS further detected Pneumocystis jirovecii. Based on these findings, the treatment plan was adjusted to include Amphotericin B complex 25 mg via intravenous (IV) qd, Tigecycline 100 mg q12h, and Sulfamethoxazole (SMZ) 0.96 g q6h for anti-infection, along with Ganciclovir 250 mg IV q12h. The patient continues to receive infusions of immunoglobulins and albumin. This case underscores the importance of monitoring MG patients on immunosuppressive therapy for opportunistic infections, emphasizing the complexity of managing multiple pathogens simultaneously.
重症肌无力（MG）是一种罕见的自身免疫性疾病，预后较差，尤其是并发机会性感染时，这在临床实践中存在重大风险。我们旨在分析一例中年男性重症肌无力患者的临床病例，该患者在免疫抑制治疗后出现严重的下消化道出血和多种机会性感染。本病例报告基于全面的临床评估，包括结肠镜检查、组织病理学检查、支气管镜检查、支气管肺泡灌洗（BAL）和宏基因组下一代测序（mNGS）。患者表现为持续性上睑下垂和肺部感染，接受美罗培南12mg每日一次（qd）、他克莫司2mg qd和溴己新60mg每日三次（tid）治疗。由于持续的下消化道出血，进行了手术。结肠镜检查发现多处溃疡，组织病理学证实为巨细胞病毒（CMV）和组织胞浆菌感染。支气管肺泡灌洗液（BALF）检测到烟曲霉、嗜蓝孢孔菌和嗜麦芽窄食单胞菌感染。mNGS进一步检测到耶氏肺孢子菌。基于这些发现，调整了治疗方案，包括静脉注射两性霉素B复合物25mg qd、替加环素100mg每12小时一次、磺胺甲恶唑（SMZ）0.96g每6小时一次进行抗感染治疗，同时给予更昔洛韦250mg静脉注射每12小时一次。患者继续接受免疫球蛋白和白蛋白输注。该病例强调了监测接受免疫抑制治疗的重症肌无力患者是否发生机会性感染的重要性，凸显了同时管理多种病原体的复杂性。
