存在肺外表现成人肺炎支原体肺炎的误诊分析

Misdiagnosis Analysis of Adult Mycoplasma Pneumoniae Pneumonia with Extrapulmonary Manifestations

目的探讨存在肺外表现成人肺炎支原体肺炎(MPP)的临床特点及误诊原因,以提高MPP的诊断水平。方法回顾性分析2017年8月—2020年6月肺炎支原体核酸检测阳性的成人MPP患者的临床资料。结果存在肺外表现的成人MPP患者32例,其中误诊11例,误诊率为34.4%。误诊时间5~15(8.7±2.9)d。11例均有咳嗽、咳痰,咳嗽多为刺激性。肺外表现:咽痛3例,肌肉关节疼痛、头痛各2例,腹泻、食欲缺乏伴恶心、皮疹、腰痛各1例。误诊疾病:浸润型肺结核、病毒性肺炎各3例,肾炎、急性胃肠炎、肺癌、咽炎、泛细支气管炎各1例。所有患者均由肺炎支原体核酸检查阳性结合胸部CT确定诊断。4例先给予阿奇霉素治疗,后因效果不佳更换为莫西沙星;1例全程给予左氧氟沙星治疗;6例首选莫西沙星治疗,其中5例疗效显著,1例因体温控制不佳,给予地塞米松5 mg静脉滴注后,体温正常,继续莫西沙星治疗,病情稳定。所有患者均治愈,无死亡病例。结论成人MPP可以肺外表现首发,对治疗效果不佳的肺外疾病,尤其是伴有发热、刺激性咳嗽病例,应考虑行肺炎支原体核酸及胸部影像学检查,从而避免或减少误诊。

Objective To explore the clinical characteristics and misdiagnosed causes of adult mycoplasma pneumoniae pneumonia(MPP)with extrapulmonary manifestations so as to improve the diagnostic level of MPP.Methods Clinical data of adult MPP patients with positive mycoplasma pneumoniae DNA during August 2017 and June 2020 was retrospectively analyzed.Results Among 32 adult MPP patients with extrapulmonary manifestations,11 were misdiagnosed,with a misdiagnosis rate of 34.4%.The duration of misdiagnosis was 5-15(8.7±2.9)d.All 11 cases had cough and expectoration,most of which were irritant.Extrapulmonary manifestations included sore throat in 3 cases,muscle and joint pain in 2 cases,headache in 2 cases,diarrhea in 1 case,anorexia with nausea in 1 case,rash in 1 case,and low back pain in 1 case.Misdiagnosed diseases included 3 cases of invasive pulmonary tuberculosis,3 cases of viral pneumonia,1 case of nephritis,1 case of acute gastroenteritis,1 case of lung cancer,1 case of pharyngitis,and 1 case of diffuse panbronchiolitis.All patients were diagnosed by the combination of positive Mycoplasma pneumoniae DNA test and chest CT.4 cases were treated with Azithromycin initially,which was withdrawn and then switched to Moxifloxacin because of poor effect;1 case was treated with Levofloxacin in the whole course;6 cases were treated with Moxifloxacin initially,of whom 5 cases had a significant effect,and 1 case was given 5 mg Dexamethasone by intravenous drip because of poor temperature control,subsequently,the temperature was normal,and Moxifloxacin treatment was continued with stable condition.All patients were cured and there was no death.Conclusion MPP in adults can be initially manifested as extrapulmonary diseases.For patients with extrapulmonary diseases and poor therapeutic effect especially those with fever and irritant cough,the detection of Mycoplasma pneumoniae DNA and chest imaging examination should be considered to avoid or reduce misdiagnosis.