环孢素致间质性肺炎1例

One case of interstitial pneumonia caused by cyclosporine

1例62岁男性患者,因膜性肾病予环孢素(75 mg,bid)联合中等剂量激素治疗。5个月后患者出现咳嗽伴发热,胸部CT提示:肺部感染,双肺多发渗出及实变改变,合并间质性肺炎。入院后停用环孢素,继续予中等剂量激素治疗膜性肾病及间质性肺炎,同时予注射用美罗培南、注射用米卡芬净钠抗感染治疗,注射用更昔洛韦钠预防巨细胞病毒感染。2 d后患者因出现呼吸衰竭转入ICU治疗,行无创面罩接呼吸机辅助通气、血浆置换、糖皮质激素及抗感染治疗。入院第8天,患者呼吸衰竭较前无改善,痰培养为嗜麦芽窄食单胞菌,美罗培南更换为注射用头孢哌酮钠舒巴坦钠。入院第13天,患者病情较前明显改善,转入呼吸内科继续行注射用头孢哌酮钠舒巴坦钠联合替加环素抗感染治疗。入院第26天,患者症状好转出院。

A 62-year-old male patient was treated with cyclosporine(75 mg,bid)and medium-dose of glucocorticoid for membranous nephropathy.After 5 months,the patient developed cough with fever.Chest CT showed lung infection,multiple exudation of both lungs with substantial changes,and interstitial pneumonia.After admission,cyclosporine was discontinued and medium-dose glucocorticoid was continued for membranous nephropathy and interstitial pneumonia.At the same time,meropenem and micafungin sodium were given to him for anti-infective treatment and ganciclovir sodium for injection was given to him for preventing cytomegalovirus infection.2 days later,he was transferred to intensive care unit(ICU)because of respiratory failure.Treatments including a non-invasive mask connected with the ventilator for assisting ventilation,plasma exchange,glucocorticoids,and anti-infective treatment were given to him after transfer.On the eighth day of admission,considered that the respiratory failure did not improve and the result of sputum culture was Stenotrophomonas maltophilia,meropenem was replaced with cefoperazone sodium and sulbactam sodium.On the 13 th day of admission,the patient’s condition improved significantly.He was transferred to the department of respiratory disease and cefoperazone sodium and sulbactam sodium injection combined with tigecycline were given to him.On the 26 th day of admission,he was discharged with the improved condition.