Bauer Marcus, Hildebrandt Anke
Department of Internal Medicine II, St. Vincenz-Krankenhaus Datteln, Datteln, Germany.
Institute of Medical Microbiology, University Hospital Münster, Münster, Germany.
IDCases. 2025 Aug 19;41:e02350. doi: 10.1016/j.idcr.2025.e02350. eCollection 2025.
Dyspnea is a common clinical symptom and cause of outpatient and inpatient presentations to the clinic. Diagnostic and therapeutic challenges appear, when additional diseases appear that are themselves associated with subjectively perceptible dyspnea. We report on a young woman with orthopnea as a trigger of a diagnostic cascade of various diseases.
A 34-year-old woman presented to our emergency department with breathing-dependent, burning thoracic pain, purulent sputum and hemoptysis for three days. Pre-existing diagnoses were psoriasis vulgaris and diabetes mellitus (type 2). Human monoclonal antibody secukinumab and methotrexate were regular drugs.We suspected a community-acquired pneumonia or bacterial co-infection of acute COVID-19. A bronchoalveolar lavage (BAL) led to the detection of -specific DNA. Methicillin-resistant was detected in the BAL, sputum and port pocket. An additional finding was a herpes zoster infection on the thorax. Further, was detected in transthoracic puncture. Guideline-based quadruple therapy (rifampicin, isoniazid, pyrazinamide and ethambutol) led to severe hepatotoxic side effects with the need of modifying the therapy.
Immunosuppression can lead to several associated infectious diseases. Before starting anti-TNF or anti-interleukin therapy, latent tuberculosis must always be ruled out. The need for cortisone therapy in immunocompromised people with COVID-19 disease must be evaluated.
呼吸困难是一种常见的临床症状，也是门诊和住院患者就诊的原因。当出现其他本身与主观可感知的呼吸困难相关的疾病时，就会出现诊断和治疗方面的挑战。我们报告了一名年轻女性，其端坐呼吸引发了一系列各种疾病的诊断过程。
一名34岁女性因呼吸相关的、烧灼样胸痛、脓性痰和咯血3天前来我院急诊科就诊。既往诊断为寻常型银屑病和2型糖尿病。人单克隆抗体司库奇尤单抗和甲氨蝶呤是常用药物。我们怀疑是社区获得性肺炎或急性COVID-19的细菌合并感染。支气管肺泡灌洗（BAL）检测到特异性DNA。在BAL、痰液和端口袋中检测到耐甲氧西林菌。另外一个发现是胸部带状疱疹感染。此外，在经胸穿刺中检测到菌。基于指南的四联疗法（利福平、异烟肼、吡嗪酰胺和乙胺丁醇）导致严重的肝毒性副作用，需要调整治疗方案。
免疫抑制可导致多种相关的感染性疾病。在开始抗TNF或抗白细胞介素治疗之前，必须始终排除潜伏性结核。对于患有COVID-19疾病的免疫功能低下者，必须评估使用皮质类固醇治疗的必要性。
