风湿性疾病合并肺孢子菌肺炎8例并文献复习

许士刚; 何双军; 李岩

doi:10.13201/j.issn.1009-5918.2021.12.011

风湿性疾病合并肺孢子菌肺炎8例并文献复习

- 1. 同济大学附属上海市第四人民院急诊科(上海, 200434);
- 2. 上海交通大学医学院附属仁济南院急诊科

详细信息

通讯作者: 李岩,E-mail:urology9999@163.com

中图分类号: R563.1

收稿日期: 2021-07-24

Rheumatic disease complicated with pneumocystis pneumonia: eight cases report and literature review

- 1 Department of Emergency, the Fourth People's Hospital Affiliated to Tongji University, Shanghai, 200434, China;
- 2 Department of Emergency, Shanghai Jiao Tong University School of Medicine Renji Nan Hospital

More Information

Corresponding author: LI Yan, E-mail: urology9999@163.com

Received Date: 24 July 2021

摘要

摘要: 目的:探讨风湿性疾病患者并发肺孢子菌肺炎的危险因素、临床特点及早期诊治要点,提高医务人员对该病的认识。方法:回顾性分析上海交通大学医学院附属仁济南院2012年12月-2020年6月住院诊治的8例风湿性疾病患者并发肺孢子菌肺炎的病例资料,并复习相关文献进行分析。结果:①8例患者均为女性,年龄为28~67岁,5例为系统性红斑狼疮,2例为肌炎,1例为成人斯蒂尔病。基础患病时间为3~120个月,诊断肺孢子菌肺炎前均使用中到大量泼尼松及免疫抑制剂治疗。5例系统性红斑狼疮患者在发生感染肺孢子菌肺炎时处于狼疮的活动期,并且累计肾脏。②除原发病临床表现外,患者最常见临床表现为新出现的发热、干嗽、气促。2例合并曲霉,1例合并毛霉,8例患者中乳酸脱氢酶、1-3β葡聚糖升高,血清白蛋白、淋巴细胞计数降低,胸部CT表现为双肺磨玻璃影,间质性病变为主。肺泡灌洗液六胺银染色可见肺孢子菌包囊,8例患者的治疗过程中均使用甲氧苄胺嘧啶-磺胺甲嗯唑和卡泊芬净的药物,经积极治疗后4例好转,3例病情恶化自动出院,1例死亡。结论:长期使用激素及免疫抑制剂治疗的风湿性疾病患者,原发疾病处于活动期、肾脏和肺脏受累、1-3β葡聚糖升高及淋巴细胞绝对值减低是并发PCP的高危因素。
- 风湿性疾病 /
- 肺孢子菌肺炎
Abstract: Objective:To investigate the risk factors and clinical characteristics of patients with rheumatic diseases complicated by pneumocystis pneumonia, as well as the main points of early diagnosis and treatment, so as to improve medical staff's understanding of the disease.Methods:A retrospective analysis was performed on 8 patients with rheumatic diseases complicated by pneumocystis pneumonia hospitalized in Renji Nan Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine from December 2012 to June 2020, and the relevant literature were reviewed.Results:①All 8 patients were female, aged from 28 to 67 years, 5 were systemic lupus erythematosus(SLE), 2 were myositis, and 1 was adult-onset still's disease. The basic illness period ranges from 3 to 120 months, and moderate to large amounts of prednisone and immunosuppressive therapy were used before the diagnosis of pneumocystis pneumonia. Five cases of SLE patients were in the active phase of lupus when pneumocystis pneumonia infection occurred, and accumulated kidney.②In addition to the primary clinical manifestations, the most common clinical manifestations of the patients were new fever, dry cough, and shortness of breath. Two cases were combined with Aspergillus and one case was combined with Mucor. In 8 cases, lactate dehydrogenase, 1-3β glucan increased, serum albumin, and lymphocyte count decreased, and chest CT showed ground glass shadows in both lungs. Mainly interstitial lesions. Pneumocystis cysts can be seen in the alveolar lavage fluid with silver hexaamine staining. Eight patients were treated with trimethoprim-sulfamethoxazole and caspofungin during the treatment process. Four cases improved after active treatment. Three cases deteriorated and were discharged automatically, and one case died.Conclusion:In patients with rheumatic diseases treated with hormones and immunosuppressive agents for a long time, the primary disease is in the active stage, the kidneys and lungs are involved, 1-3β glucan increased and the absolute value of lymphocytes is decreased are high risk factors.
- rheumatic diseases /
- pneumocystis pneumonia

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