UNASSIGNED: A 66-year-old man with glucocorticoid therapy for 9 years had a fever after getting a cold and developed respiratory failure rapidly within 3 days. He was given trimethoprim-sulfamethoxazole empirically before Pneumocystis pneumonia (PCP) was confirmed with the presence of cysts in the sputum. Although there was a partial improvement of symptoms, an area of consolidation on the left upper lung lobe gradually enlarged. Bronchoscopy was performed 3 times and Mycobacterium tuberculosis infection was finally diagnosed. For 1 years, he was treated with standard antituberculosis agents, and his psychological well-being was managed using traditional Chinese medicine techniques. After 3 years of follow-up, his outcome was very good.
UNASSIGNED: HIV-seronegative patients on long-term glucocorticoid therapy in areas with a high incidence of Mycobacterium tuberculosis may be co-infected with Pneumocystis jirovecii. When opportunistic infections are suspected, diagnostic procedures including invasive ones should be performed as soon as possible and appropriate interventions need to be carried out promptly.
■一名66岁男子接受糖皮质激素治疗9年,感冒后发烧,并在3天内迅速发展为呼吸衰竭。在确认痰中存在囊肿之前,先根据经验给予甲氧苄啶-磺胺甲恶唑。虽然症状有部分改善,左上肺叶实变区逐渐增大。进行3次支气管镜检查,最终诊断为结核分枝杆菌感染。1年来,他接受了标准的抗结核药物治疗,他的心理健康是用中医技术管理的。经过3年的随访,他的结果非常好。
■在结核分枝杆菌高发地区接受长期糖皮质激素治疗的HIV血清阴性患者可能与肺孢子虫合并感染。当怀疑机会性感染时,包括侵入性诊断程序在内的诊断程序应尽快进行,并且需要及时进行适当的干预措施。