皮肌炎併發肺囊蟲肺炎：病例報告

發燒、咳嗽有痰及呼吸費力常見原因很多，臨床上常被診斷肺炎或上呼吸道感染，但若無即早鑑別診斷，很容易惡化至呼吸衰竭，甚至死亡。本文描述一位62歲男性因發燒合併咳嗽有痰及呼吸費力至本院求治，初診斷為非典型肺炎，本身有癌症及免疫方面疾病，長期服用免疫抑制劑及類固醇。廣效性抗生素治療後臨床狀況仍持續惡化，緊急行氣管內管置入併呼吸器輔助治療，經重新審視病史、肺部電腦斷層呈現毛玻璃樣之變化及支氣管鏡檢行氣管肺泡刷洗液檢查後確診為肺囊蟲肺炎。雖然於支氣管鏡檢結果出來前，已開始給予肺囊蟲肺炎治療，但患者仍無法避免因免疫低下，導致二次肺部感染併敗血症，最終治療失敗死亡。因此，針對免疫力低下合併嚴重肺炎者，須將肺囊蟲肺炎納入鑑別診斷，避免因延遲診斷、治療，導致死亡。

關鍵字

皮肌炎；肺囊蟲肺炎；非免疫缺陷病毒患者； TMP-SMX（trimethoprim-sulfamethoxazole）

並列摘要

Compilation of fever, productive cough and dyspnea have various kind of differential diagnosis and was most frequently diagnosed as community-acquired pneumonia. The potential etiologic organisms were broad, and severe pneumonia could progress rapidly to respiratory failure and even death. Hereby, we described a 62-year-old male presented with fever, productive cough, and dyspnea, initially diagnosed as atypical pneumonia. The patient had underlying history of malignancy and autoimmune disease; therefore, he was long-term under disease modifying antirheumatic drug and systemic corticosteroid. Despite administration of broad-spectrum antibiotics, the patient rapidly deteriorates to respiratory failure, requiring ventilator support. After reviewing his clinical history, appearance of ground glass opacities on chest CT scan and performing bronchoalveolar lavage (BAL), the patient was finally diagnosed with pneumocystis pneumonia (PJP). Though the patient received treatment of PJP while awaiting results for BAL, his condition continued to decline, with development of bacterial superinfection. Due to sepsis with multi-organ failure, the patient died on the 17th day of hospitalization. PJP should be suspected in immunocompromised individuals with severe pneumonia, as PJP is a potentially life-threatening fungal infection.

並列關鍵字

Pneumocystis Pneumonia ； Non-immunodeficiency disease ； TMP-SMX(trimethoprim-sulfamethoxazole)

國際替代計量

皮肌炎併發肺囊蟲肺炎：病例報告

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