- 期刊
Pulmonary Opportunistic Infections in a Lung Cancer Patient Treated with Inhaled Corticosteroid
肺部機緣性感染於一接受吸入性類固醇治療之肺腺癌病患：病例報告
摘要
肺部機緣性感染包括巨細胞病毒肺炎(cytomegalovirus, CMV pneumonitis)及肺孢子蟲感染(Pneumocystis jiroveci pneumonia, PcP)在非人類免疫不全病毒感染之免疫不全病患，包括血癌及接受免疫抑制劑治療者等仍不屬常見。回顧醫學文獻並沒有發現吸入性的類固醇治療會在慢性肺病或是肺癌的病患導致機緣性感染；在此我們報告一位六十三歲肺腺癌病患於接受吸入性類固醇治療、放射治療及標靶治療(geftinib)後發生致死性的PcP及CMV肺炎。在沒有因爲使用化學治療且沒有證據顯示放射治療引發明顯的白血球缺乏的情況下，我們強調使用吸入性類固醇於易感受性之宿主，例如慢性肺病及肺癌等之病患時若發生快速進展的氣喘、胸悶及發燒等症狀應及早懷疑肺部機緣性感染的可能，亦應注意合併其他機緣性感染的可能。臨床醫師可藉由分子生物學的方法及早診斷，並應視情況追蹤CD4淋巴球的數量及投與預防性或治療性的抗生素。
關鍵字
無資料並列摘要
Opportunistic pulmonary infections, including Pneumocystis jiroveci pneumonia (PcP) and cytomegalovirus (CMV) pneumonitis are uncommon in human immunodeficiency virus (HIV)-seronegative persons who are immunocompromised on account of hematological malignancy, immunosuppressive therapy, or a primary immunodeficiency. PcP remains an infrequent event among patients with solid tumor malignancies. Here we report a 63 year-old stage IIB lung cancer patient who developed fatal PcP and CMV pneumonitis after treated with inhaled steroid, radiotherapy and gefitinib. She had not been treated with chemotherapy; and the radiotherapy she received had not caused obvious leucopenia. In the absence of obvious immunosuppressive effects resulting from chemotherapy or radiotherapy, we suggest that the use of inhaled corticosteroid might increase the susceptibility of pulmonary opportunistic infections in potentially immunocompromised hosts, i.e., COLD or lung cancer patients, even in the absence of marked leucopenia. Susceptible patients who are treated with inhaled corticosteroid developing rapid evolution of dyspnea, substernal chest tightness, nonproductive cough and fever should be considered as suffering from PcP and should be treated accordingly until proven otherwise. Coinfection with other opportunistic pathogens should be identified and treated concurrently. Following up lymphocyte or CD4 count and prophylaxis measures are advocated in selected patients.