PDF(Pubmed)
Abstract：
Pneumocystis carinii pneumonia (PCP), which is currently referred to as Pneumocystis jirovecii pneumonia, is an opportunistic fungal infection that commonly affects immunocompromised patients, and it is potentially fatal. Individuals at risk include those whose host immunity has been altered by underlying disease states, such as HIV and cancer patients, as well as transplant recipients and those taking immunosuppressive medications. Here, we present a case of a breakthrough PCP infection of an adult allogeneic hematopoietic stem cell transplant patient who was infected despite prophylaxis with inhaled pentamidine. The patient\'s transplant course was complicated by acute graft-versus-host disease (GVHD), which was treated with tacrolimus, prednisone, beclomethasone, and budesonide. Treatments for GVHD, which include immunosuppressive therapies, are a risk factor for PCP. Thus, the patient was on prophylactic treatment with inhaled pentamidine. The case presents challenges that immunocompromised patients face, particularly those undergoing allogeneic hematopoietic stem cell transplantation. While the patient received prophylactic treatment, there was still a breakthrough PCP infection. We highlight the risks this infection can cause and the need to promptly address these infections to prevent complications and optimize prophylactic regimens.
摘要：
卡氏肺孢子虫肺炎(PCP),目前被称为焦氏肺孢子虫肺炎，是一种机会性真菌感染，通常会影响免疫功能低下的患者，它可能是致命的。处于危险中的个体包括宿主免疫力因潜在疾病状态而改变的个体，比如艾滋病毒和癌症患者，以及移植接受者和服用免疫抑制药物的人。这里,我们介绍了一例突破性PCP感染的成人异基因造血干细胞移植患者,该患者尽管接受了吸入喷他脒的预防,但仍被感染.患者的移植过程并发急性移植物抗宿主病（GVHD），用他克莫司治疗，泼尼松,倍氯米松,还有布地奈德.GVHD的治疗，其中包括免疫抑制疗法，是PCP的危险因素。因此，患者正在接受吸入喷他脒的预防性治疗.该病例提出了免疫功能低下患者面临的挑战，尤其是接受异基因造血干细胞移植的患者。当患者接受预防性治疗时，仍有突破性的PCP感染。我们强调了这种感染可能导致的风险，以及及时解决这些感染以预防并发症和优化预防方案的必要性。
