迁延不愈的“肺炎”1例

A case report of prolonged pneumonia

大动脉炎肺动脉受累(Takayasu′s arteritis-pulmonary artery involvement,TA-PAI)是一种累及肺动脉及其分支的慢性进行性炎性疾病,多数患者早期表现为发热、呼吸困难、胸痛等非特异性呼吸系统症状,误诊率较高。目前TA-PAI的诊断主要依据大动脉炎的诊断标准及肺动脉受累的影像学证据,但肺动脉受累未被纳入常用的大动脉炎诊断标准,导致TA-PAI尤其是孤立性肺动脉受累诊断率可能被严重低估。本文报道1例26岁的女性患者,反复胸痛伴发热,外院诊断为“肺炎”,治疗4个月未见明显好转,后因咯血发作于我院就诊,最终确诊为大动脉炎肺动脉受累,予激素、免疫抑制剂以及肺血管介入治疗后病情稳定。通过分析该病例的临床特点及诊疗思路,并复习相关文献,提高临床医生对大动脉炎肺动脉受累的认识。

Takayasu′s arteritis-pulmonary artery involvement(TA-PAI)is a chronic,progressive,inflammatory disease affecting the pulmonary artery and its branches.Patients typically present with non-specific respiratory symptoms,such as fever,dyspnea,and chest pain,leading to a high rate of misdiagnosis.The diagnosis of TA-PAI is currently based on the diagnostic criteria of aortitis and imaging evidence of pulmonary artery involvement.However,pulmonary artery involvement is not typically included in the diagnostic criteria for aortitis,which may lead to a significant underestimation of the diagnostic rate of TA-PAI,particularly in cases where pulmonary artery involvement is the only manifestation.This article reports the case of a 26-year-old female patient who presented with recurrent chest pain and fever.She was initially diagnosed with pneumonia in a foreign hospital but did not show significant improvement after four months of treatment.Eventually,she was diagnosed with pulmonary artery involvement in aortitis and was stabilized with hormones,immunosuppressive drugs,and pulmonary vascular intervention.By analyzing the clinical features and diagnostic and therapeutic approaches of this case,and reviewing the relevant literature,clinicians can improve their understanding of TA-PAI.