以肺炎为主要表现的获得性免疫缺陷综合征误诊报告

A Misdiagnosis Report on Acquired Immunodeficiency Syndrome with Pneumonia as Main Symptom

目的探讨以肺炎为主要表现的获得性免疫缺陷综合征的临床特点及误诊原因、防范措施。方法对2017年12月—2019年8月收治的曾误诊为单纯肺炎的获得性免疫缺陷综合征5例的临床资料进行回顾性分析。结果5例均出现发热、咳嗽、咳痰和气短;合并真菌性食管炎1例,余既往均身体健康;皆否认吸毒史;4例有不洁性生活史。5例就诊初期均经胸部CT检查诊断为单纯肺炎,误诊时间5 d~2个月。5例按单纯肺炎给予正规抗感染治疗7~14 d效果不理想,后常规完善传染病4项检查,人类免疫缺陷病毒均阳性,方诊断获得性免疫缺陷综合征。5例确诊后4例转入定点医院,1例放弃治疗,后均失访。结论获得性免疫缺陷综合征合并肺炎近年呈现增长趋势,且已从高危人群转向普通人群,加之缺乏典型临床表现,易发生误诊。加强对其认识,仔细询问病史和查体,对疑似患者和高危人群常规进行人类免疫缺陷病毒抗体初筛,以减少或避免获得性免疫缺陷综合征误诊。

Objective To investigate clinical characteristics,misdiagnosed causes and preventive measures of acquired immunodeficiency syndrome(AIDS)with pneumonia as main sign.Methods Clinical data of 5 patients with AIDS misdiagnosed as having pneumonia during December 2017 and August 2019 was retrospectively analyzed.Results All 5 patients had fever,cough,expectoration and shortness of breath.One patient complicated with fungal esophagitis,and the other patients had been in good health.All patients denied history of drug abuse,and unhealthy sex life was reported in 4 patients.All the 5 patients were initially diagnosed as having pneumonia by chest CT examination,and misdiagnosed duration was 5 d to 2 months.Regular anti-infection treatment for 7-14 d was ineffective for all patients,and the results of human immunodeficiency virus were positive after conventional test for four infectious diseases,and then the patients were diagnosed as having AIDS.After confirming diagnosis,4 patients were transferred to the designated hospital,1 gave up treatment,and all the patients were lost to follow-up.Conclusion AIDS complicated with pneumonia has shown an increasing trend in recent years,which has shifted from high-risk groups to the general population.In addition,clinical manifestations are atypical,and therefore AIDS complicated with pneumonia is prone to misdiagnosis.AIDS may be avoid or reduce by strengthening the understanding of AIDS,carefully inquiring about medical history,performing physical examination carefully and preliminary screening tests for human immunodeficiency virus in suspected patients and high-risk groups.