PDF(Pubmed)
Abstract：
Pegfilgrastim dramatically reduces febrile neutropenia (FN) caused by high-risk chemotherapy. This report details the presentation of a 72-year-old female who developed a fatal infection of Pseudomonas aeruginosa pneumonia that occurred during preoperative chemotherapy despite pegfilgrastim administration. She was brought to the hospital with symptoms of high fever and general fatigue during chemotherapy, but her respiratory symptoms were minimal, and a chest computed tomography (CT) showed no obvious signs of pneumonia. She had FN. After she was hospitalized, her breathing and consciousness worsened rapidly, and the chest CT showed prominent lobar pneumonia. Her blood cultures suggested P. aeruginosa, so she was quickly switched to meropenem. She was diagnosed with septic shock and acute respiratory distress syndrome due to severe P. aeruginosa pneumonia, and she was started on noninvasive positive pressure ventilation with immunoglobulin preparations. P. aeruginosa developed drug resistance, so it was necessary to change antibiotics. She was discharged without complications of pulmonary fibrosis on chest CT. It is crucial to always be aware that severe infections can occur even with pegfilgrastim administration, promptly identify the causative pathogen, and intervene with early treatment.
摘要：
Pegfilgrastim可显着减少高风险化疗引起的发热性中性粒细胞减少症（FN）。该报告详细介绍了一名72岁的女性，尽管使用了pegfilgrastim，但在术前化疗期间发生了致命的铜绿假单胞菌肺炎感染。她在化疗期间出现高烧及全身乏力的症状被送往医院,但她的呼吸道症状很少,胸部计算机断层扫描（CT）没有明显的肺炎迹象。她有FN。她住院后,她的呼吸和意识迅速恶化，胸部CT显示突出的大叶性肺炎。她的血培养显示铜绿假单胞菌,所以她很快就换成了美罗培南.由于严重的铜绿假单胞菌肺炎，她被诊断为感染性休克和急性呼吸窘迫综合征，她开始使用免疫球蛋白制剂进行无创正压通气。铜绿假单胞菌出现耐药性，所以有必要更换抗生素。胸部CT无肺纤维化并发症出院。至关重要的是要始终意识到即使使用pegfilgrastim也可能发生严重感染，及时识别致病病原体，并进行早期治疗。
