• 文章类型: Case Reports
    产生粒细胞集落刺激因子(G-CSF)的肺肿瘤很少见,他们的成像特征和有效的治疗仍然难以捉摸。同样,间充质-上皮转化(MET)外显子14跳跃突变也不常见。在这里,我们报道一例产生G-CSF的肺腺癌MET第14外显子跳跃突变阳性,模仿肺脓肿。一名61岁男子出现咳嗽和高烧。对比增强胸部计算机断层扫描显示肿块有腔和内部液体积聚。患者最初接受肺脓肿的诊断治疗,但最终被诊断为MET外显子14跳跃突变阳性的肺腺癌。在替替尼治疗后,原发病变缩小,血清G-CSF水平下降,导致产生G-CSF的肺癌的诊断。产生G-CSF的肺肿瘤可以呈现模拟肺脓肿的影像学发现。Tepotinib治疗可能对MET外显子14跳跃突变的患者有效,包括那些产生G-CSF的肺癌。
    Granulocyte colony-stimulating factor (G-CSF)-producing lung tumours are rare, with their imaging features and effective treatments remaining elusive. Similarly, mesenchymal-epithelial transition (MET) exon 14 skipping mutations are also uncommon. Herein, we report a case of G-CSF-producing lung adenocarcinoma positive for a MET exon 14 skipping mutation, mimicking lung abscess. A 61-year-old man presented with cough and high fever. Contrast-enhanced chest computed tomography revealed a mass with a cavity and internal fluid accumulation. The patient initially underwent diagnostic treatment for a lung abscess but was ultimately diagnosed with lung adenocarcinoma positive for a MET exon 14 skipping mutation. Following tepotinib therapy, the primary lesion shrank, and serum G-CSF levels decreased, leading to a diagnosis of G-CSF-producing lung cancer. G-CSF-producing lung tumours can present imaging findings that mimic lung abscesses. Tepotinib therapy may be effective for patients with MET exon 14 skipping mutation, including those with G-CSF-producing lung cancer.
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  • 文章类型: Case Reports
    腰大肌脓肿是一种相对罕见的疾病,可以表现出模糊的临床特征。患有这种疾病的患者通常以不同的方式出现在不同的专科,导致诊断和管理延迟。
    作者介绍了一名47岁的女性,主诉腹部模糊疼痛,发烧,接受CT检查的炎症标志物升高。在CT上,在右髂窝中发现了一个集合,该集合沿着右腹膜后延伸,穿过右肺基部的后外侧间隙,与具有空气-液体水平的空洞性肺病变连通。腰大肌脓肿被引流。
    我们的案例呈现了许多罕见和有趣的特征。值得注意的是,病人,有免疫能力的人,经历了原发性葡萄球菌感染,迅速发展为相当大的肺脓肿,在这样的宿主中不常见的现象。稀有性进一步延伸到感染源,起源于腹部,但通过腹膜后部位的连续扩散最终导致胸部并发症。尽管潜在的严重性,患者的结果非常积极。
    该病例强调了腰大肌脓肿肺部受累的潜在速度,强调在术前评估期间需要提高对呼吸体征的认识和考虑。
    UNASSIGNED: Psoas abscess is a relatively uncommon condition that can present with vague clinical features. Patients with this condition often present in different ways to different specialties leading to delays in diagnosis and management.
    UNASSIGNED: The authors present a 47-year-old woman with complaint of vague abdominal pain, fever, and raised inflammatory markers who underwent CT examination. On CT, a collection was noted in the right iliac fossa that extended along the right retroperitoneum through the retrocrural space in the right lung base communicating with a cavitary pulmonary lesion with air-fluid level. The psoas abscess was drained.
    UNASSIGNED: Our case presents a number of rare and intriguing features. Notably, the patient, who was immunocompetent, experienced a primary Staphylococcus infection that swiftly progressed to a sizable pulmonary abscess, a phenomenon uncommon in such hosts. The rarity further extends to the source of infection, originating abdominally but culminating in thoracic complications through contiguous spread from a retroperitoneal site. Despite the potential severity, the patient\'s outcome was remarkably positive.
    UNASSIGNED: This case underscores the potential rapidity of pulmonary involvement in psoas abscesses, emphasizing the need for heightened awareness and consideration of respiratory signs during preoperative assessments.
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  • 文章类型: Case Reports
    肺动脉假性动脉瘤(PAP)并不常见,然而,它们经常导致咯血,并与不良预后有关。我们报告一例87岁男性患者。最初,他住进了以前的医院,诊断为左下叶肺脓肿.在第二个住院日,他出现咯血.对比增强胸部计算机断层扫描(CT)确定了感染性肺动脉假性动脉瘤。第九个住院日,肺动脉弹簧圈栓塞术成功,显著改善患者的病情。
    Pulmonary artery pseudoaneurysms (PAPs) are uncommon, yet they frequently result in hemoptysis and are associated with a poor prognosis. We report a case of an 87-year-old male patient. Initially, he was admitted to a previous hospital, and diagnosed with a lung abscess in the left lower lobe. On the second hospital day, he developed hemoptysis. A contrast-enhanced chest computed tomography (CT) identified an infectious pulmonary artery pseudoaneurysm. On the ninth hospital day, pulmonary artery coil embolization was successfully performed, significantly improving the patient\'s condition.
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  • 文章类型: Case Reports
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  • 文章类型: Case Reports
    背景:坏死梭杆菌(F.坏死)引起的坏死性肺炎是一种罕见但严重的肺部感染。微生物检测方法不足会导致诊断困难。
    方法:我们报告1例通过支气管肺泡灌洗液(BALF)的下一代测序(NGS)诊断为坏死F.肺脓肿。
    结果:BALF-NGS检测到F。指导后续靶向抗生素治疗。用主动引流和甲硝唑治疗,病人的病情得到有效治疗。
    结论:BALF-NGS是快速诊断由难以培养的细菌引起的感染的有价值的工具。它在坏死F.的早期鉴定中起着决定性的作用,能够及时和有针对性的抗生素干预。早期诊断和适当的治疗对于坏死F.肺炎的治疗至关重要。
    BACKGROUND: Fusobacterium necrophorum (F. necrophorum)-induced necrotizing pneumonia is a rare but severe pulmonary infection. Insufficient microbiological detection methods can lead to diagnostic difficulties.
    METHODS: We report a case of F. necrophorum lung abscess diagnosed by next-generation sequencing (NGS) of bronchoalveolar lavage fluid (BALF).
    RESULTS: BALF-NGS detected F. necrophorum, guiding subsequent targeted antibiotic therapy. With active drainage and metronidazole treatment, the patient\'s condition was effectively treated.
    CONCLUSIONS: BALF-NGS is a valuable tool for the rapid diagnosis of infections caused by difficult-to-culture bacteria. It played a decisive role in the early identification of F. necrophorum, enabling timely and targeted antibiotic intervention. Early diagnosis and appropriate treatment are crucial for the management of F. necrophorum pneumonia.
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  • 文章类型: Case Reports
    耶和华见证人是一个基督教教派,因其坚决拒绝输血而受到广泛认可,即使面临严重的贫血。我们描述了一个42岁的耶和华见证人患有严重缺铁性贫血的独特病例。在继发于食道阻塞的复杂坏死性吸入性肺炎的情况下,她需要对错位的胃带进行手术矫正。这种严重贫血的医疗管理一直是传统方法的挑战,比如输血,是不可能的。相反,一种多方面的方法已经被描述为静脉注射铁,重组人促红细胞生成素,维生素B12,叶酸,和维生素C管理。我们强调,关于耶和华见证人患者严重贫血管理的指南协议缺乏共识,随后需要对此事进行更多调查。它还强调了通过患者与其医疗保健提供者之间的密切合作来尊重患者自主权的重要性,以确保有效的以患者为中心的护理。
    Jehovah\'s Witnesses is a Christian denomination widely recognized for their steadfast refusal of blood transfusions, even when facing severe anemia. We describe a unique case of a 42-year-old Jehovah\'s Witness woman with severe iron deficiency anemia. She necessitated surgical correction of a malpositioned gastric band within the context of a complex necrotizing aspiration pneumonia secondary to esophageal obstruction. Medical management of this severe anemia has been a challenge as traditional approaches, like a blood transfusion, are not possible. Instead, a multifaceted approach has been described with intravenous iron infusions, recombinant human erythropoietin, vitamin B12, folate, and vitamin C administration. We emphasize the lack of consensus on guideline protocols regarding management of severe anemia for Jehovah\'s Witness patients and the subsequent need for more investigation into that matter. It also underscores the significance of respecting patient autonomy through close collaboration between patients and their health care providers to ensure effective patient-centered care.
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  • 文章类型: Case Reports
    Longbeachae军团菌是澳大利亚军团菌病的最常见原因。军团菌被认为是胸膜感染的罕见原因,以前从未报道过由长贝氏乳杆菌引起的脓胸和肺脓肿。我们的病人有2-3周的呼吸困难史,嗜睡,干咳和头痛。最初的胸部X光片显示广泛的左侧巩固并伴有胸腔积液。在计算机断层扫描扫描上明显的坏死性肺炎区域演变成多部位肺内脓肿。痰培养分离的LongbeacheeL.,这促使在缓冲木炭酵母提取物琼脂上培养胸膜液并分离生物体。该病例提供了Longbeachae可引起脓胸和肺脓肿的证据。在它盛行的地区,应考虑增加使用军团菌特异性琼脂进行胸水培养。
    Legionella longbeachae is the most common cause of Legionnaires\' disease in Australasia. Legionella species are considered a rare cause of pleural infection, and empyema and lung abscess due to L. longbeachae has not previously been reported. Our patient presented with a 2-3 week history of breathlessness, lethargy, dry cough and headaches. Initial chest radiograph showed extensive left sided consolidation with an associated pleural effusion. An area of necrotising pneumonia evident on computed tomography scan evolved into a multiloculated intrapulmonary abscess. Sputum culture isolated L. longbeachae, which prompted culture of pleural fluid on buffered charcoal yeast extract agar and isolation of the organism. This case provides evidence that L. longbeachae can cause both empyema and lung abscess, and in areas where it is prevalent, increased use of Legionella specific agar for pleural fluid culture should be considered.
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  • 文章类型: Case Reports
    一份独特的病例报告,可能是印度的第一个案例,本文报道了先前未经治疗的2型糖尿病患者中由中间链球菌引起的肺脓肿。患者表现为非生产性咳嗽和右侧胸痛。微生物学评估证实存在中间链球菌,患者对抗生素治疗反应积极。该病例强调了S.intermedius可能在免疫受损个体中充当病原体的事实。所以,医学界在忽视它作为共生之前需要谨慎行事。
    A unique case report, probably first case from India, of lung abscess caused by Streptococcus intermedius in a previously untreated patient with Type 2 diabetes mellitus is reported here. The patient presented with non-productive cough and right-sided chest pain. Microbiological evaluation confirmed the presence of Streptococcus intermedius and the patient responded positively to antibiotic therapy. This case highlights the fact that S.intermedius may act as pathogen in immunocompromised individuals. So, a caution is needed by the medical fraternity before disregarding it as a commensal.
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  • 文章类型: Journal Article
    背景:肺炎克雷伯菌入侵综合征(KPIS)是一种严重的多部位感染,通常由高毒力肺炎克雷伯菌引起。这种细菌在亚洲糖尿病患者中相对常见,可引起器官脓肿或败血症。当患者发生颅内感染时,预后较差。抗感染治疗后,肺炎克雷伯菌所致肝、肺脓肿及肺部真菌感染均得到缓解,但是脑脓肿恶化了.这种复杂和严重的感染病例很少报道。早期发现颅内感染,选择脑脊液中高浓度的抗生素,糖尿病、真菌感染等并发症的积极治疗对患者预后具有重要意义。
    方法:另一医院诊断为肝脓肿的71岁患者因病情恶化转入我院。在第1天(入院日),患者接受有创机械通气,连续性肾脏替代疗法联合内毒素吸附,亚胺培南-西司他丁抗菌治疗,经皮穿刺置管引流术治疗肝脓肿。支气管肺泡灌洗液中的宏基因组下一代测序表明肺炎克雷伯菌(K。肺炎),白色念珠菌,和黄曲霉复合物,没有检测到病毒。血液和脓液培养显示肺炎克雷伯菌对哌拉西林/他唑巴坦敏感。抗感染治疗调整为哌拉西林/他唑巴坦联合伏立康唑。在第14天,头部计算机断层扫描(CT)扫描显示没有明显变化,胸部CT扫描显示双肺有多个脓肿吸收。病人仍然昏迷。拔除气管导管后,头颅磁共振成像(MRI)显示多发性脑脓肿。最后,他的家人放弃了,患者出院并在当地医院死亡。
    结论:在肺炎克雷伯菌感染病例中,颅内的可能性,肝脏,肺,或其他部位感染应考虑,医生应警惕KPIS的发生。对于怀疑发生颅内感染的病人,应尽快检测和培养脑脊液,应该进行头部MRI,应早期使用脑脊液中高分布的抗生素。当患者患有糖尿病时,除了血糖控制,同时也需要警惕真菌感染.
    BACKGROUND: Klebsiella pneumoniae invasion syndrome (KPIS) is a severe multi-site infection that is usually caused by hypervirulent Klebsiella pneumoniae. The bacteria are relatively common in Asian diabetics and can cause organ abscesses or sepsis. When patients develop intracranial infection, the prognosis is poor. After anti-infective treatment, the Klebsiella pneumoniae-induced liver and lung abscesses and pulmonary fungal infection were relieved, but the brain abscesses worsened. Such complex and severe infection cases are rarely reported. Early identification of intracranial infection, selection of antibiotics with high concentrations in cerebrospinal fluid, and active treatment of complications such as diabetes and fungal infection are of great significance for the prognosis of patients.
    METHODS: A 71-year-old patient diagnosed with liver abscess in another hospital was transferred to our hospital due to a worsening condition. On day 1 (day of admission), the patient was given invasive mechanical ventilation, continuous renal replacement therapy combined with endotoxin adsorption, antimicrobial treatment with imipenem-cilastatin, and percutaneous catheter drainage for liver abscess. Metagenomic next-generation sequencing in bronchoalveolar lavage fluid indicated Klebsiella pneumoniae (K. pneumoniae), Candida albicans, and Aspergillus flavus complex, and no viruses were detected. Blood and pus cultures revealed K. pneumoniae that was sensitive to piperacillin/tazobactam. The anti-infection therapy was adjusted to piperacillin/tazobactam combined with voriconazole. On day 14, a head computed tomography (CT) scan showed no significant changes, and a chest CT scan showed absorption of multiple abscesses in both lungs. The patient was still unconscious. After the endotracheal tube was removed, cranial magnetic resonance imaging (MRI) showed multiple brain abscesses. Finally, his family gave up, and the patient was discharged and died in a local hospital.
    CONCLUSIONS: In cases of K. pneumoniae infection, the possibility of intracranial, liver, lung, or other site infections should be considered, and physicians should be vigilant for the occurrence of KPIS. For patients suspected of developing an intracranial infection, cerebrospinal fluid should be tested and cultured as soon as possible, a head MRI should be performed, and antibiotics with high distribution in cerebrospinal fluid should be used early. When patients are complicated with diabetes, in addition to glycemic control, vigilance for concurrent fungal infections is also needed.
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    文章类型: Case Reports
    我们介绍了一例24岁女性,有发烧和背痛史。她没有特殊的病史,也没有服用任何药物。经胸超声心动图和计算机断层扫描显示动脉导管未闭,肺动脉中有植被。她用青霉素G治疗;然而,植被栓塞到左肺动脉.抗生素改为克林霉素和头孢曲松后,计算机断层扫描(CT)显示肺脓肿的分辨率。两个月后,动脉导管未闭的手术修复成功。动脉导管未闭相关的感染性心内膜炎在成年期相对罕见。
    We present a case of a 24-year-old female who presented with a history of fever and back pain. She had no particular medical history and was not taking any medication. Transthoracic echocardiology and computed tomography showed a patent ductus arteriosus with vegetation in the pulmonary artery. She was treated with penicillin G;however, the vegetation embolized into the left pulmonary artery. After the antibiotics was changed to clindamycin and ceftriaxone, the resolution of the lung abscess was shown by computed tomography( CT). Two months later, a surgical repair of the patent ductus arteriosus was successfully performed. Patent ductus arteriosus-associated infectious endocarditis is relatively rare in adulthood.
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