系统性红斑狼疮合并播散性诺卡菌病1例并文献复习

Case report and literature of systemic lupus erythematosus combined with disseminated nocardiosis

目的提高多播散性诺卡菌病的认识和诊治水平。方法分析2019年10月复旦大学附属中山医院呼吸与危重症医学科收治的1例系统性红斑狼疮合并播散性诺卡菌感染病例的临床和影像表现、实验室检查、诊治过程,并进行文献复习。结果播散性诺卡菌病患者多有免疫缺陷,临床和影像表现缺乏特异性,确诊主要依赖病原学检查。结论对于免疫缺陷的患者出现发热等呼吸道症状,胸部CT见实变、肿块影、结节影、胸腔积液等,特别是合并皮下脓肿时,应考虑播散性诺卡菌病的可能,尽快取得病原学诊断予以正规、联合和足疗程治疗可降低该病的复发率和病死率。

Objective To improve the diagnosis and treatment of disseminated nocardiosis.Methods The clinical features,radiological findings,laboratory testings,diagnosis,and treatment were analyzed in a case(admitted to the Department of Pulmonary and Critical Care Medicine,Zhongshan Hospital,Fudan University in October 2019)diagnosed with systemic lupus erythematosus combined with disseminated nocardiosis,and the related literatures were reviewed.Results Nocardiosis is a rare and life-threatening opportunistic infection in immunocompromised patients.The clinical and radiological manifestations of nocardia infections are very heterogeneous and nonspecific.Therefore,the diagnosis mainly relies on pathogenic examination.Conclusions For immunosuppressed patients,disseminated nocardiosis should be considered when they had respiratory symptoms including fever,cough,and purulent sputum,elevated inflammtory makers,and consolidations,nodules,mass and pleural effusions shown in the chest CT,especially accompanied by subcutaneous abscess.Obtaining as soon as possible the etiologic diagnosis and the standard,combined,and full course treatment can reduce the recurrence rate and fatality rate of the disease.