甲泼尼龙合用吗替麦考酚酯诱发系统性红斑狼疮患者肺孢子虫肺炎

Pneumocystis pneumonia induced by methylprednisolone combined with mycophenolate mofetil in treatment of a patient with systemic lupus erythematosus

1例60岁系统性红斑狼疮女性患者,初始服用甲泼尼龙40mg,1次/d,用甲泼尼龙治疗45d后加用吗替麦考酚酯0.75g,2次/d,用药38d后出现发热、胸闷、低氧血症。X线胸片示双肺纹理增多模糊,双肺野呈磨玻璃样。给予哌拉西林-三唑巴坦钠和莫西沙星抗感染治疗,效果欠佳。实验室检测示CD4+T淋巴细胞亚群计数为103/mm3,支气管肺泡灌洗液检出伊氏肺孢子菌,确诊为肺孢子虫肺炎。遂将吗替麦考酚酯减量至0.5g,并给予卡泊芬净50mg/d,联磺甲氧苄胺2片,4次/d,用药第5天患者胸闷、呼吸困难好转。

A 60-year-old woman with systemic lupus erythematosus initially received oral methylprednisolone 40 mg/d.After 45 days of methylprednisolone therapy,mycophenolate mofetil 0.75 g was added to her regimen.A further 38 day＇s later,the patient developed fever,tight chest,and hypoxemia.A chest X-ray showed that the lines in her lungs was increased and blurred,and her lung field was ground-glass pattern.Laboratory tests revealed that her CD4＋ T-lymphocyte count was 103/mm3,and pneumocystis jirovecii was detected in her brochovesicular lavage solution.The patient was diagnosed with pneumocystis pneumonia.The dosage of mycophenolate mofetil was reduced to 0.5 g twice daily.In addition,caspofungin 50 mg/d and 2 sulfamethoxazole,sulfadiazine and trimethoprim tablets four times daily were given.Five days after drug administration,her tight chest and dyspnea improved.