军团菌肺炎合并多器官功能衰竭报告1例

A case of Legionella pneumonia with multiple organ failure

军团菌肺炎是一种罕见系统感染性疾病,临床表现不典型,容易漏诊。2015年3月长沙市中心医院肾内科收治了1例发热伴呼吸困难患者,初期以社区获得性肺炎治疗,效果不佳;随后出现横纹肌溶解、急性肝肾功能衰竭及神经系统损害。免疫学检查提示军团菌抗体阳性,考虑为军团菌肺炎并发多器官功能衰竭,通过莫西沙星联合阿奇霉素抗感染及连续性血液净化治疗后病情好转。当对社区获得性肺炎患者进行抗生素治疗无效,同时并发多器官功能衰竭时需考虑嗜肺军团菌肺炎,在联合应用大环内酯类及氟喹诺酮类抗感染基础上积极治疗并发症能显著改善军团菌肺炎患者预后。

Legionella pneumonia （LP） is a rare systemic infectious disease, which is often misdiagnosed by clinicians due to the atypical symptoms. A middle-aged man who suffered from fever and dyspnea was diagnosed as community acquired pneumonia （CAP） in Changsha Central Hospital in March 2015. The treatment was unsatisfied firstly. The patients showed further symptoms of rhabdomyolysis, acute liver and renal failure, and impaired neural functions, who was diagnosed as LP with multiple organ failure based on a positive test for Legionella antibody. The patient was recovered after treated with moxifloxacin combined with azithromycin and continuous renal replacement therapy. LP should be paid attention when patient was diagnosed as CAP and failed to be treated. The satisfied outcome is achieved after application of macrolide, quinolones and comprehensive treatments.