新型冠状病毒感染后并发急性嗜酸粒细胞性肺炎的临床诊疗特点

The Clinical Diagnosis and Treatment of Acute Eosinophilic Pneumonia After SARS-CoV-2 Infection

目的探讨新型冠状病毒(SARS-CoV-2)感染后并发急性嗜酸粒细胞性肺炎(AEP)的临床特征、诊疗特点及预后。方法选择于2023年6月15日河北医科大学附属医院邢台市人民医院收治的1例新型冠状病毒感染后并发急性嗜酸粒细胞性肺炎的患者为研究对象,本研究对患者随访截至2023年12月15日。采用回顾性分析方法,结合该患者的临床资料及国内外文献报道的病例进行综合分析加以总结。结果本例患者为77岁的男性。起初无明显诱因出现发热、咳嗽、咳痰、气喘,新型冠状病毒核酸检测阳性,在外院住院给予抗炎抗感染等对症治疗后效果欠佳,于2023年6月15日以“肺炎”收治我院呼吸科进行治疗。胸部CT示右肺下叶肺炎、双侧胸腔积液,经抗感染等对症治疗效果欠佳,肺泡灌洗液(BALF)中找到嗜酸性粒细胞计数42%,考虑急性嗜酸粒细胞性肺炎,在抗感染基础上加用糖皮质激素治疗后好转。随访至2023年12月15日,患者病情未复发。结论COVID-19在极少数情况下可以引发AEP,AEP可作为COVID-19感染患者的鉴别诊断,尤其是抗感染治疗效果欠佳的患者。

Objective To investigate clinical characteristics,as well as the status of diagnosis and treatment,and prognosis of acute eosinophilic pneumonia(AEP)after SARS-CoV-2 infection.Methods On June 15,2023,a patient with acute eosinophilic pneumonia after SARS-CoV-2 infection admitted to Xingtai People’s Hospital affiliated to Hebei Medical University was selected as the research object.This patient was then followed up until December 15th,2023.We used a retrospective analysis method for a comprehensive analysis,by combining the clinical data of this patient and cases previously reported in domestic and foreign literatures.Results The studied patient was a 77-year-old male.At first,there was no obvious cause of fever,cough,expectoration and asthma,and PCR for SARS-CoV-2 was positive.The effect of anti-inflammatory and anti-infective treatment in the external hospital was poor.On June 15th,2023,the patient was admitted to the Respiratory Department of our hospital with“pneumonia”for treatment.Chest CT showed pneumonia in the lower lobe of the right lung and bilateral pleural effusion.Symptomatic treatments,such as anti-infection,were not effective,and 42%of eosinophils were found in bronchoalveolar lavage fluid(BALF).Acute eosinophilic pneumonia was considered,and treatment with glucocorticoids on the basis of anti-infection showed improved effects.The follow-up was conducted until December 15th,2023,and there was no recurrence of the patient’s condition.Conclusion COVID-19 can trigger AEP in rare cases,and AEP can be used as a differential diagnosis for COVID-19 infected patients,especially those with poor anti-infection treatment effects.