Diagnostic Challenge for Positive 1,3-β-D-Glucan in an Immunocompromised Patient Receiving Intravenous Immunoglobulin Presenting With Respiratory Failure.

1, 3 - β - D - 葡聚糖阳性在接受静脉免疫球蛋白并伴有呼吸衰竭的免疫功能低下患者中的诊断挑战。

• 发表时间: 2024 May
• 来源期刊: Cureus
• DOI: 10.7759/cureus.61121
• PMID: 38919241
• 文章类型: Case Reports
• 作者列表: Im S,Garces E,Roedder T,Charini W

关键词: beta-d glucan; false-positive diagnosis; fungal lung infection; immunocompromised; immunocompromised hosts; pneumocytis jiroveci

Abstract

Diagnosing Pneumocystis jirovecii pneumonia (PJP) can be complex, particularly in cases of significant respiratory failure. The 1,3-β-D-glucan (BDG) serum assay has emerged as a promising non-invasive diagnostic tool for detecting fungal infections, including PJP. However, factors that can confound the interpretation of BDG levels by causing elevation in serum levels have been documented. Here, we present the case of 51-year-old woman with underlying autoimmune disorder, hematologic malignancy, and chronic steroid use, who was admitted for acute hypoxemic respiratory failure. Obtaining the BDG assay after the administration of intravenous immunoglobulin (IVIG) posed a diagnostic challenge, as the patient was unable to undergo bronchoscopy. This circumstance led to a debate regarding the possibility of a false-positive BDG due to IVIG use or the presence of PJP. Ultimately, the patient was empirically treated for PJP. This case underscores the importance of comprehending factors that may contaminate BDG results, particularly in immunocompromised individuals.

摘要

肺孢子虫肺炎（PJP）的诊断可能很复杂，特别是在严重呼吸衰竭的情况下。1,3-β-D-葡聚糖（BDG）血清测定已成为检测真菌感染的有前途的非侵入性诊断工具，包括PJP。然而,已记录了通过导致血清水平升高而混淆BDG水平解释的因素。这里,我们介绍了一个51岁的女性，患有潜在的自身免疫性疾病，恶性血液病,和长期使用类固醇，因急性低氧性呼吸衰竭入院。静脉注射免疫球蛋白（IVIG）后获得BDG测定提出了诊断挑战，患者无法进行支气管镜检查。这种情况引起了关于由于IVIG的使用或PJP的存在而导致假阳性BDG的可能性的争论。最终,患者接受了PJP的经验性治疗.这一案例强调了理解可能污染BDG结果的因素的重要性，特别是在免疫受损的个体中。