艾滋病并卡氏肺孢子虫肺炎误诊误治1例分析并文献复习

Report and Document Review of Misdiagnosis and Therapeutic Error of AIDS Complicating PCP

目的分析艾滋病(AIDS)合并卡氏肺孢子虫肺炎(PCP)的临床和影像学表现,总结其诊断经验,并分析误诊原因。方法回顾性分析1例AIDS合并PCP患者诊断治疗过程的临床资料,分析误诊原因,并进行相关文献复习。结果该患者被误诊为甲状腺功能亢进、普通肺炎,延误了治疗,发展为Ⅰ型呼吸衰竭,就诊地坛医院确诊为AIDS合并PCP,经机械通气,磺胺、克林霉素治疗后症状好转,继续抗病毒治疗。结论当综合医院非感染科医师遇到临床表现为体质量下降、发热、呼吸困难和发绀为主的患者时,特别是年轻男性,胸部影像学表现出双肺弥漫性对称性小结节,网格状、磨玻璃样改变时,应警惕AIDS合并PCP的可能。

Objective To analyze the clinical manifestations and imaging features of AIDS complicating PCP, and to sum up the experience of diagnosis and the causation of misdiagnosis. Methods Clinical data of the case of AIDS complicating PCP＇s misdiagnosis and therapeutic error were retrospectively analyzed and pertinent documents were reviewed. Results The patient who initially went to a general hospital was misdi- agnosised and delayed in treatment. It rapidly developed into type I respiratory failure. Then, it was diaganosed as acquired immunodeficiency syndrome complicated with pneumocystis carinii pneumonia by Di- tan Hospital. After the treatment of mechanical ventilation, use of sulfanilamide and clindamycin, the condi- tion was improved, and antiviral therapy was continued. Conclusion When the patients, especially young males, have the symptoms like weight loss, fever, dyspnea and cyanosis, with chest imaging features of diffu- sivlty ground glass opacity, reticulo-nodular changes in double lungs, the doctors should be alerted to the possibility of AIDS complicating PCP.