PDF(Pubmed)
Abstract：
UNASSIGNED: Lymphoma is complicated by intricate infections, notably Pneumocystis jirovecii pneumonia (PJP), marked by rapid progression, respiratory failure, and high mortality. Rapid diagnosis of PJP and effective administration of the first-line treatment trimethoprim-sulfamethoxazole (TMP-SMX) are important. For patients intolerant to TMP-SMX, selecting appropriate alternatives is challenging, necessitating careful decisions to optimize diagnosis and treatment. We present a lymphoma case complicated by PJP, illustrating medication adjustment until a positive response was observed.
UNASSIGNED: A 41-year-old male patient with lymphoma presented with a week-long history of fever, fatigue, cough, sputum, chest tightness, and exertional dyspnea, unresponsive to treatment. Routine laboratory examinations revealed no pathogenic bacteria. PJ and Mycobacterium tuberculosis (MTB) were detected in bronchoalveolar lavage fluid (BALF) using metagenomic next-generation sequencing (mNGS). On Day 1 of admission, meropenem, TMP-SMX, and rifampicin+isoniazid+levofloxacin were administered. However, the patient developed drug-induced hepatotoxicity and gastrointestinal adverse reactions after six days of treatment. After a multidisciplinary team discussion, anti-tuberculosis therapy was stopped because of insufficient evidence of tuberculosis infection. A reduced dose of TMP-SMX with micafungin was used for PJP; however, symptoms persisted and repeated computed tomography showed extensive deterioration of bilateral pulmonary plaques. The PJP regimen was modified to include a combination of TMP-SMX and caspofungin. Due to the high fever and elevated infection indices, the patient was treated with teicoplanin to enhance the anti-infection effects. By Day 13, the patient\'s temperature had normalized, and infection control was achieved by Day 30. CT revealed that the infection in both lung lobes fully resolved. Subsequently, lymphoma treatment commenced.
UNASSIGNED: BALF-NGS facilitates early and rapid diagnosis of PJP. mNGS reads of MTB bacillus <5 may indicate a bacterial carrier state, warranting other detection techniques to support it. There is insufficient evidence for using TMP-SMX with micafungin to treat PJP; however, TMP-SMX combined with caspofungin is suitable.
UNASSIGNED: A 41-year-old male patient with lymphoma presented with a week-long history of fever, fatigue, cough, sputum, chest tightness, and exertional dyspnea, unresponsive to treatment. Routine laboratory examinations revealed no pathogenic bacteria. PJ and Mycobacterium tuberculosis (MTB) were detected in bronchoalveolar lavage fluid (BALF) using metagenomic next-generation sequencing (mNGS). On Day 1 of admission, meropenem, TMP-SMX, and rifampicin+isoniazid+levofloxacin were administered. However, the patient developed drug-induced hepatotoxicity and gastrointestinal adverse reactions after six days of treatment. After a multidisciplinary team discussion, anti-tuberculosis therapy was stopped because of insufficient evidence of tuberculosis infection. A reduced dose of TMP-SMX with micafungin was used for PJP; however, symptoms persisted and repeated computed tomography showed extensive deterioration of bilateral pulmonary plaques. The PJP regimen was modified to include a combination of TMP-SMX and caspofungin. Due to the high fever and elevated infection indices, the patient was treated with teicoplanin to enhance the anti-infection effects. By Day 13, the patient\'s temperature had normalized, and infection control was achieved by Day 30. CT revealed that the infection in both lung lobes fully resolved. Subsequently, lymphoma treatment commenced.
UNASSIGNED: BALF-NGS facilitates early and rapid diagnosis of PJP. mNGS reads of MTB bacillus <5 may indicate a bacterial carrier state, warranting other detection techniques to support it. There is insufficient evidence for using TMP-SMX with micafungin to treat PJP; however, TMP-SMX combined with caspofungin is suitable.
摘要：
■淋巴瘤是复杂的感染，特别是肺孢子虫肺炎（PJP），以快速发展为标志，呼吸衰竭,和高死亡率。PJP的快速诊断和甲氧苄啶-磺胺甲恶唑（TMP-SMX）的一线治疗的有效给药很重要。对于不耐受TMP-SMX的患者，选择合适的替代品是具有挑战性的，需要谨慎的决定来优化诊断和治疗。我们提出一例淋巴瘤并发PJP,说明药物调整，直到观察到阳性反应。
一名41岁男性淋巴瘤患者，有一周的发热史，疲劳,咳嗽,痰,胸闷,和劳力性呼吸困难，对治疗没有反应。常规实验室检查未发现致病菌。使用宏基因组下一代测序（mNGS）在支气管肺泡灌洗液（BALF）中检测到PJ和结核分枝杆菌（MTB）。在入学的第一天，美罗培南,TMP-SMX,利福平+异烟肼+左氧氟沙星给药。然而,治疗6天后,患者出现了药物性肝毒性和胃肠道不良反应.经过多学科小组讨论，抗结核治疗因结核感染证据不足而停止.减少剂量的TMP-SMX与米卡芬净一起用于PJP；然而，症状持续存在,反复CT显示双侧肺斑块广泛恶化.对PJP方案进行了修改，包括TMP-SMX和卡泊芬净的组合。由于高烧和感染指数升高，患者接受替考拉宁治疗以增强抗感染作用。到第13天，病人的体温已经恢复正常，并且在第30天实现感染控制。CT显示两个肺叶的感染已完全解决。随后，淋巴瘤治疗开始。
■BALF-NGS有助于PJP的早期和快速诊断。MTB杆菌的mNGS读数<5可能表明细菌载体状态，保证其他检测技术来支持它。使用TMP-SMX联合米卡芬净治疗PJP的证据不足；然而，TMP-SMX结合卡泊芬净是合适的。
一名41岁男性淋巴瘤患者，有一周的发热史，疲劳,咳嗽,痰,胸闷,和劳力性呼吸困难，对治疗没有反应。常规实验室检查未发现致病菌。使用宏基因组下一代测序（mNGS）在支气管肺泡灌洗液（BALF）中检测到PJ和结核分枝杆菌（MTB）。在入学的第一天，美罗培南,TMP-SMX,利福平+异烟肼+左氧氟沙星给药。然而,治疗6天后,患者出现了药物性肝毒性和胃肠道不良反应.经过多学科小组讨论，抗结核治疗因结核感染证据不足而停止.减少剂量的TMP-SMX与米卡芬净一起用于PJP；然而，症状持续存在,反复CT显示双侧肺斑块广泛恶化.对PJP方案进行了修改，包括TMP-SMX和卡泊芬净的组合。由于高烧和感染指数升高，患者接受替考拉宁治疗以增强抗感染作用。到第13天，病人的体温已经恢复正常，并且在第30天实现感染控制。CT显示两个肺叶的感染已完全解决。随后，淋巴瘤治疗开始。
■BALF-NGS有助于PJP的早期和快速诊断。MTB杆菌的mNGS读数<5可能表明细菌载体状态，保证其他检测技术来支持它。使用TMP-SMX联合米卡芬净治疗PJP的证据不足；然而，TMP-SMX结合卡泊芬净是合适的。
