在患有全身性红斑狼的患者中,由传播的加密球菌引起的扩散膜出血
Takao Nagashima1, Hiroki Yabe1, Toshiaki Ogishi1
1Division of Rheumatology, First Department of Comprehensive Medicine, Saitama Medical Center, Jichi Medical University, Saitama, JPN.
Cureus
|March 11, 2024
概括
系统性红斑狼 (SLE) 患有扩散膜出血 (DAH) 的患者需要进行彻底的感染查. 一名患有DAH的十几岁SLE患者被诊断出患有扩散性密码球菌病,需要抗真菌治疗.
科学领域:
- 免疫学 免疫学 免疫学
- 传染性疾病 传染性疾病
- 肺部病理学 肺部病理学
背景情况:
- 系统性红斑狼 (SLE) 是一种自身免疫性疾病,可以影响多个器官.
- 扩散膜出血 (DAH) 是一种罕见但严重的SLE的肺表现.
- 真菌感染,特别是Cryptococcus neoformans,可以在免疫功能低下的患者中呈现机会性感染.
研究的目的:
- 报告一个患有SLE和DAH的十几岁青少年病人的传播性加密球菌病例.
- 突出排除在SLE患者患有DAH的感染的重要性.
- 讨论同时存在的SLE和传播的真菌感染的管理.
主要方法:
- 一个患有SLE的十几岁女性患者的病例报告.
- 临床表现:发烧,咳,呼吸不良.
- 诊断工作:胸部CT,支气管支气管洗 (BAL) 液体分析,血液和BAL液体培养.
- 治疗方法:葡萄糖皮质醇脉冲疗法,脂质体安福特里辛B,细胞素.
主要成果:
- 胸部CT显示扩散的透和中间腺淋巴病变.
- BAL液体建议使用DAH.
- 血液和BAL液体培养证实了Cryptococcus neoformans的生长.
- 这名患者被诊断患有扩散型密码球菌病,并接受抗真菌药物治疗,并逐渐减少普雷迪尼索隆的剂量.
结论:
- 在SLE患者中,传播的密码菌病可以模仿或与DAH共存.
- 及时识别和治疗机会性感染对于免疫功能低下的患者至关重要.
- 在SLE患者中,与DAH一样的肺部症状有很高的感染怀疑指数是合理的.
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