Aoki Y, Hohsa K, Fukuno Y, Fujisawa N, Naitoh K, Hayashi S, Nagasawa K
Department of Medicine, Saga Medical School.
Kansenshogaku Zasshi. 1998 Oct;72(10):1080-3. doi: 10.11150/kansenshogakuzasshi1970.72.1080.
A fifty year-old female who had previously been well presented with a productive cough and a high fever. Her initial chest X-ray film showed no abnormal lung shadows. Despite partial improvement of the fever and the serum level of acute phase reactant (CRP) in response to intravenous administration of piperacillin, she complained of increasing severity of cough and dyspnea. Follow-up chest X-ray films taken five days after therapy with piperacillin showed diffuse nodular shadows in the mid-to-lower lung fields bilaterally. Chest CT scan disclosed diffuse miliary nodules at the lung periphery and thickening of bronchovascular markings. Chest auscultation revealed late inspiratory coarse crackles and expiratory wheezing, and the patient's arterial oxygen tension was 61 mmHg. Suspected of suffering from primary atypical pneumonia, she was started on therapy with intravenous minocyclin (200 mg/day), two days after treatment her symptoms began improving significantly. Anti-mycoplasma antibody was found to be x 1280, and cold hemoagglutinin x 1024, establishing the diagnosis of Mycoplasma pneumoniae infection. The patient's condition completely recovered following a one week treatment with minocyclin. We concluded that her respiratory infection was caused by piperacillin-sensitive mico-organism, and also Mycoplasma pneumoniae which brought about hypoxic acute bronchiolitis to the patient.
一名50岁女性，此前身体状况良好，出现了咳痰和高热症状。她最初的胸部X光片显示肺部无异常阴影。尽管静脉注射哌拉西林后发热和急性期反应物（CRP）血清水平有所部分改善，但她仍抱怨咳嗽和呼吸困难加剧。哌拉西林治疗五天后的胸部X光片显示双侧中下肺野有弥漫性结节状阴影。胸部CT扫描显示肺周边有弥漫性粟粒结节以及支气管血管纹理增粗。胸部听诊发现吸气末粗湿啰音和呼气哮鸣音，患者动脉血氧分压为61mmHg。怀疑患有原发性非典型肺炎，在治疗两天后开始静脉注射米诺环素（200mg/天），她的症状开始明显改善。抗支原体抗体检测结果为x1280，冷凝集素为x1024，确诊为肺炎支原体感染。患者经米诺环素治疗一周后病情完全康复。我们得出结论，她的呼吸道感染是由对哌拉西林敏感的微生物引起的，同时还有肺炎支原体，后者给患者带来了缺氧性急性细支气管炎。
