EB病毒复燃导致弥漫性肺泡出血1例及文献复习

Case Report and Literature Review for Diffuse Alveolar Hemorrhage Caused by Recurrent Epstein-Barr Virus Infection

成人EB病毒(EBV)感染的发病率逐渐增高,特别是老年人,急性感染症状不明显,容易忽视。本文报道1例EBV复燃导致弥漫性肺泡出血患者的诊治过程并复习相关文献。该患者以咳嗽、咳痰、喘憋、发热起病,治疗过程中病情曾一度好转,但随后出现咳血、呼吸困难、血红蛋白降低以及低氧血症。肺部CT弥漫浸润影,诊断为肺泡出血。究其病因,考虑为EBV感染所致,给予持续呼吸机辅助呼吸、激素冲击联合抗病毒治疗,以及血液净化、抗感染等综合治疗后病情好转。该结果提示及时使用足量激素联合免疫抑制剂等综合治疗有利于改善患者预后。临床诊疗过程中应进一步提高对病毒感染的认识和关注程度,辅助疾病的早期诊断及治疗。

The incidence of Epstein-Barr virus(EBV)infection is increasing in adults,especially in the elderly population,and it is easily ignored as the symptoms of acute infection are not obvious.This article reports the diagnosis and treatment of diffuse alveolar hemorrhage in one patient caused by recurrent EBV infection with the review of relevant literature.The patient presented cough,expectoration,wheezing and dyspnea,and fever at the onset of disease,and showed transient improvement during the treatment before experiencing hemoptysis,dyspnea,decreased hemoglobin,and hypoxemia.Diffuse infiltration shadow was shown in the lung CT and diagnosed as pulmonary alveolar hemorrhage,with the etiology considered to be the EBV infection.The condition was improved after comprehensive treatment with continuous ventilator-assisted breathing,hormone pulse combined with antiviral therapy,blood purification,anti-infection therapy,etc.The results suggest that timely use of adequate hormone combined with immunosuppressive agents contributes to the improvement in the prognosis of the patients.The awareness and attention towards the virus infection should be increased in the clinical diagnosis and treatment process to help the early diagnosis and treatment of diseases.