诺卡菌重症肺炎合并菌血症1例报告

Severe Nocardia pneumonia with bacteremia:A case report

报道1例成人斯蒂尔病,患者为71岁女性,因反复发热、咽痛、皮疹入院。予激素等免疫抑制剂治疗2月后,出现气促转入成人重症监护室(AICU)。入AICU完善相关检查后确诊为诺卡菌重症肺炎合并菌血症,予敏感抗生素、呼吸机辅助、俯卧位通气、体外膜肺氧合(ECMO)支持、连续性肾脏替代(CRRT)、毒素吸附等治疗一度好转后病情反复,最终因重症肺炎死亡。诺卡菌病是一种机会性感染,若为诺卡菌血症,则死亡率极高。早期识别诊断,尽早充分治疗,有望提高诺卡菌血症患者的生存率。

A case of adult Stil's disease was reported.The patient was a seventy-one-year-old female who was admitted to the hospital with recurrent fever,sore throat,and rash.After two months of corticosteroids and other immunosuppressive therapy,she developed dyspnea and was transferred to the Adult Intensive Care Unit(AICU).Severe Nocardia pneumonia with bacteremia was confirmed after perfecting her inspection.After sensitive antibiotics,a ventilator,prone position ventilation,extracorporeal membrane oxygenation(ECMO),continuous renal replacement therapy(CRRT),toxin adsorption,and other treatments,she once improved for a while and then deteriorated again.Ultimately,she died of severe pneumonia.Nocardiosis is an opportunistic infection.Nocardia bacteremia is a highly fatal disease.Early diagnosis and adequate treatment are expected to improve the survival rate of patients with Nocardia bacteremia.