长期低剂量类固醇治疗引起的肺囊炎肺炎病例
Motoyasu Nakamura1,2,3, Keisuke Suzuki3, Eriko Yoshida2
1General Medicine Department, Tone Health Cooperative Society, Tone Central Hospital, Gunma, JPN.
Cureus
|November 6, 2025
概括
肺囊性肺炎 (PCP) 即使在低剂量,长期使用皮质类固醇时也可能发生. 这一案例凸显了在免疫功能低下的患者中考虑PCP的重要性,无论每天服用多少类固醇.
科学领域:
- 传染性疾病 传染性疾病
- 肺部病理学 肺部病理学
- 免疫学 免疫学 免疫学
背景情况:
- 肺囊炎肺炎 (PCP) 是一种由肺囊炎 jirovecii引起的机会性感染.
- 它主要影响到晚期艾滋病毒或其他免疫功能低下状态的个体,包括那些长期服用皮质类固醇的人.
- 标准预防指导方针往往侧重于更高的每日类固醇剂量,可能会忽视与慢性低剂量治疗相关的风险.
研究的目的:
- 在长期服用低剂量口服普雷迪尼索隆的老年患者中报告PCP病例.
- 强调在接受慢性皮质类固醇治疗的患者的肺炎差异诊断中需要考虑PCP,无论每日剂量如何.
- 要突出诊断挑战和管理的PCP在一个非艾滋病毒免疫受损的主机.
主要方法:
- 一个80岁的男性患有类风湿性关节炎的病例研究,长期服用低剂量普雷尼索隆.
- 分析了Pneumocystis jirovecii的临床表现,诊断工作,包括胸部成像 (放射和CT),实验室测试 (beta-D-glucan) 和唾液PCR.
- 评估了对三甲胺-硫甲醇 (TMP-SMX) 和阿托瓦昆的治疗反应.
主要成果:
- 患者发烧和低氧化,最初怀疑为细菌性肺炎.
- 诊断测试通过皮PCR证实了Pneumocystis jirovecii的存在.
- 治疗TMP-SMX和阿托瓦昆导致临床改善和低氧化症的解决.
结论:
- 长期的皮质类固醇治疗,即使是每日低剂量,也会增加由于累积暴露的机会性感染的风险,如PCP.
- 在慢性皮质类固醇患者的肺炎差异诊断中,无论每日剂量如何,应强烈考虑PCP.
- 这一案例强调了在多种免疫受损人群中对PCP的警诊断和管理的重要性.
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