Pneumocystis Carinii Pneumonia in an AIDS Patient with Dramatic Response to Inadvertent Steroid Therapy - A Case Report

後天免疫缺乏症候群病人併囊蟲炎對腎上腺素的效應‧‧‧‧‧‧病例報告

蔡米山(Mee-Sun Tsai) ； 蔡瑞熊(Juei-Hsiung Tsai) ； 劉宏文(Hong-Wen Liu) ； 陳田柏(Tyen-Po Chen) ； 簡崇和(Chung-Ho Chien) ； 劉文章(Wen-Jan Liu) ； 黃吉志(Jhi-Jhu Hwang) ； 王致皓(Zyh-Haw Wang)

《The Kaohsiung Journal of Medical Sciences》 5卷6期 (1989/06) Pp. 345-349

https://doi.org/10.6452/KJMS.198906.0345

摘要

本文報告一典型28歲男性同性戀後天免疫缺乏症群病人。此病人不但免疫缺失，CD4CD8細胞減少，CD4／CD8細胞比值反轉，而且酵素免疫壬應和西方墨點試驗證明後天免疫缺乏病毒感染。病人經胸腔鏡生檢證實併有囊蟲感染，胸部X光呈現瀰漫性浸閏，動脈血液氣體分析呈現低血氧，功能檢查則有限制性呼吸功能障礙。臨床上可見高燒咳嗽和呼吸困難的現象。在正確診斷建立之前，為緊急改善病患的呼吸衰竭的對症治療，病人對腎上腺的治療反應，其臨床症候，肺功能能和胸部X光檢查均顯著的改善。腎上腺素或許可以短期地使用在由於後天免疫缺乏症候群合併肺囊蟲肺炎的呼吸衰竭病人中補助療法，但仍無法取代其他抗微生物藥物用以治療後天免疫缺乏症候群的病人。

並列摘要

A 28 year-old homosexual man had one month history of intermittent high fever, nonproductive cough and progressive shortness of breath. He not only had immunity deficits, with decreased CD4 cells, decreased CD8 cells and inverted CD4/ CD8 ratio, but also presented with evidence of human immunodeficiency virus infection (positive ELISA antibody tests and Western blot tests). Chest X-ray showed diffuse pulmonary infiltration. The arterial blood gases revealed hypoxemia. The PaO2 was 69 mmHg. Spirometry showed FVC 2.28 L(45%predicted), FEV1 2.21 L(49%predicted), FEV1/FVC 93%, and MMEF 4.41 L/sec (90%predicted). The configuration of the Flow-Volume loop was consistent with a restrictive ventilatory defect. Transthoracic lung biopsy demonstrated pneumocystis carinii pneumonia (PCP). He had inadvertent stroid therapy and showed some clinical, pulmonary function and chest X-ray improvement before the diagnosis was established Steroids might be as adjunctive therapy for a short period of syndrome (AIDS) at respiratory failure.

並列關鍵字

pneumocystis carinii pneumonia ； acquired immunodeficiency syndrome ； steroid