感染诱发机化性肺炎误诊分析

Analysis of Misdiagnosis of Infection-induced Organizing Pneumonia

目的探讨感染诱发机化性肺炎的临床特点,分析误诊原因。方法回顾性分析14例感染诱发机化性肺炎的临床资料,并复习相关文献。结果本组均表现为咳嗽、咳痰,病程7～48 d,误诊时间1周～3个月,误诊为单纯肺部感染8例,肺癌3例,真菌感染不除外2例,肺脓肿1例,均予相应处理未见好转。后完善相关医技检查,明确病原体感染8例,其中甲流病毒、结核杆菌感染各2例,腺病毒、军团菌、大肠埃希菌、肺炎克雷伯杆菌感染各1例,且均行活组织病理检查,确诊为感染诱发机化性肺炎,其中6例予抗感染、糖皮质激素及对症治疗,患者体温下降,咳痰好转; 8例予抗感染及支持治疗后病情好转出院。随访1年,患者病情均未反复。结论临床遇及初始治疗无效的呼吸道感染患者,应警惕感染诱发机化性肺炎的可能,及时行病原学检测及病理检查,争取早期确诊并治疗,以改善预后。

Objective To investigate the clinical characteristics of organizing pneumonia induced by infection and to analyze the reasons for misdiagnosis.Methods The clinical data of14cases of organizing pneumonia induced by infection were retrospectively analyed,and relevant literature was reviewed.Results Cough and speutum were the most common symptoms in infection-induced organizing pneumonia.The course of disease was7to48d.The duration of misdiagnosis was1week to3months.Eight patients were misdiagnosed as pure pulmonary infection,3as lung cancer,2as suspected mycotic infection,and1as pulmonary abscess.The symptoms did not get improvement after symptomatic treatment.After the relevant examinations and inspections,infectious pathogens were identified in8patients.Influenza A virus and mycobacterium tuberculosis were found in2patients,respectively,and adenovirus,legionella,Escherichia coli and klebsiella pneumoniae were found in1case,respectively.Organizing pneumonia induced by infection was confirmed by lung tissue biopsy.The body temperature was lowered and cough was alleviated in6cases after anti-infection,glucocorticoid,and symptomatic treatment.The remaining8cases were discharged after symptoms were relieved due to anti-infection and supportive treatments.At1-year follow-up,the patients'condition was stable.Conclusion Organizing pneumonia induced by infection should be taken into account for patients respiratory infection who had poor response to anti-infection.Pathogenic detection and pathological examination should be performed timely for early diagnosis and treatment in order to improve the prognosis.