- 期刊
Pneumocystis Jirovecii Pneumonia in a Patient with Smoldering Adult T Cell Leukemia/Lymphoma
在鬱積型成人Ｔ細胞白血病／淋巴瘤病人罹患肺囊蟲肺炎：病例報告
摘要
肺囊蟲是在免疫不全的宿主最常見的伺機感染之一，但卻很少在免疫健全的成年人身上造成症狀。我們報告一個58歲健康男性於2年多前被診斷罹患肺囊蟲肺炎之病例。他表現出漸進氣促，咳嗽和輕度體重減輕持續了2個月的時間。支氣管鏡肺部活檢證實感染肺囊蟲肺炎。調查所有可能造成免疫抑制狀態原因的檢查都顯示陰性結果。經過肺囊蟲肺炎治療，一系列的胸部影像檢查均顯示肺部病變逐步改善。經過20個月的後續追蹤，病人發生了上呼吸道感染症狀，舌根部腫瘤，口腔念珠菌病，和兩側頸部淋巴結腫大，因而診斷成人T細胞白血病／淋巴瘤。最後，儘管在積極的化學治療和準備異體周邊血液幹細胞移植，他仍在2個月後因病情惡化與併發傳染性疾病而去世。因此我們更要全面去檢查且密切追蹤這些病人是否有免疫功能低下疾病的臨床表現。（胸腔醫學2012；27：117-123）
並列摘要
Pneumocystis jirovecii is 1 of the most common opportunistic infections in immunocompromised hosts, but rarely causes symptoms in immunocompetent adults. We report the case of a healthy 58-year-old male who was diagnosed with Pneumocystis pneumonia about 2 years ago. He presented with progressive dyspnea on exertion, dry cough and mild body weight loss for 2 months. Pneumocystis jirovecii pneumonia was proven by transbronchial lung biopsy. A survey for possible causes of the immunosuppressed status, including anti-HIV and venereal disease research laboratory tests, and hemograms, showed negative results, and no history of Chinese herb or steroid use was traced. After treatment for Pneumocystis pneumonia, serial chest radiographs showed gradual resolution of the lung lesions. After 20 months of follow-up, he developed the symptoms of upper airway infection, tongue base tumor, oral candidiasis, and bilateral neck lymphoadenopathies; adult T cell leukemialymphoma (ATLL) was then diagnosed. The patient died 2 months later due to disease progression, despite chemotherapy and treatment for complicated infections. In conclusion, a healthy patient with Pneumocystis infection should be considered as a healthy human T-cell lymphotropic virus type 1 (HTLV-1) carrier or smoldering ATLL patient. (Thorac Med 2012; 27: 117-123)
延伸閱讀
- Wu, W. J., Kuo, L. K., Lee, C. H., Wu, C. L., & Lin, R. L. (2017). 治療愛滋病及肺囊蟲肺炎後出現與免疫重建發炎症候群相關的肺部卡波西氏肉瘤－病例報告. 胸腔醫學, 32(2), 98-104. https://www.airitilibrary.com/Article/Detail?DocID=10239855-201704-201703270013-201703270013-98-104
- Chuang, W. C., Lin, C. C., Lin, J. M., Yeh, D. Y. W., Jiang, J. S., & Kao, S. J. (2006). 瀰漫性泛細支氣管炎併發成人T細胞白血病－病例報告. 胸腔醫學, 21(1), 94-100. https://doi.org/10.29806/TM.200602.0015
- Tseng, W. Y., Lai, K. H., Lo, G. H., Wu, H. B., Tsai, C. C., & Tseng, H. H. (1997). T細胞淋巴瘤侵犯肝臟和末端迴腸合併血球吞噬症候群：一病例報告. 中華民國消化系醫學雜誌, 14(3), 258-263. https://doi.org/10.6557/GJTb.199709_14(3).0005
- Yong, K. K., Wu, T. C., Lee, Y. J., Chen, C. P., & Tsao, T. C. Y. (2008). 肺囊蟲肺炎感染併發急性呼吸迫症候群發生在免疫健全者一病例報告. 胸腔醫學, 23(2), 138-143. https://doi.org/10.29806/TM.200804.0010
- Tsai, Y. M., Huang, M. S., Tsai, J. R., Su, Y. C., Liu, Y. C., & Hwang, J. J. (2008). 原發性肺惡性淋巴瘤－淋巴漿細胞惡性淋巴瘤：病例報告及文獻回顧. 胸腔醫學, 23(2), 95-102. https://doi.org/10.29806/TM.200804.0004