PDF(Pubmed)
Abstract：
A man in his 80s with a history of sarcoidosis on chronic prednisone presented to the emergency department with several days of dyspnoea. A chest X-ray showed signs of pneumonia, and the patient was admitted. Blood and pleural fluid cultures grew Nocardia farcinica; therefore, the patient was started on treatment with trimethoprim-sulbactam and imipenem. Brain imaging showed evidence of dissemination of the infection to the central nervous system (CNS). The patient\'s admission was complicated by pleural effusions, acute kidney injury and pancytopenia, and therefore, his antibiotic regimen was ultimately transitioned from trimethoprim-sulfamethoxazole (TMP-SMX), meropenem and linezolid to imipenem and tedizolid. The patient received imipenem and tedizolid for the remainder of the admission. A repeat MRI of the brain was performed after 6 weeks of this dual antibiotic therapy, which unfortunately revealed persistent CNS disease. His regimen was then broadened to TMP-SMX, linezolid and imipenem. Despite these measures, however, the patient ultimately passed away from the infection.
摘要：
一名80多岁，有慢性泼尼松结节病病史的男子因几天呼吸困难被送往急诊科。胸部X光显示有肺炎的迹象,病人入院了.血液和胸膜液培养物生长了诺卡氏菌；因此，患者开始接受甲氧苄啶-舒巴坦和亚胺培南治疗.脑成像显示感染扩散到中枢神经系统（CNS）的证据。患者入院时并发胸腔积液，急性肾损伤和全血细胞减少症，因此,他的抗生素治疗方案最终从甲氧苄啶-磺胺甲恶唑（TMP-SMX）过渡，美罗培南和利奈唑胺到亚胺培南和替地唑胺。患者在入院的剩余时间内接受亚胺培南和替地唑胺治疗。在这种双重抗生素治疗6周后，进行了大脑的重复MRI，不幸的是，它揭示了持续性的中枢神经系统疾病。然后他的治疗方案被扩大到TMP-SMX，利奈唑胺和亚胺培南。尽管采取了这些措施,然而,病人最终因感染而去世。
