抗γ-干扰素自身抗体阳性耐多药结核病并发马尔尼菲等多重感染一例并文献复习

A case of multiple infections such as multidrug-resistant tuberculosis caused by positive anti-interferon-γ autoantibodies and literature review

目的: 报告1例抗γ-干扰素自身抗体阳性导致的耐多药结核病并发马尔尼菲等多重感染患者的诊治过程,并结合文献分析该病的临床特征、实验室检查、治疗及预后。方法: 回顾性分析2023年8月2日首都医科大学附属北京胸科医院收治的1例抗γ-干扰素自身抗体阳性导致的耐多药结核病并发马尔尼菲等多重感染患者的相关临床资料。检索截止时间2024年5月31日,分别从PubMed数据库中以“Anti-interferon-γ autoantibodies、Multidrug-resistant tuberculosis”同时为检索词,从万方数据库、中国知网以“抗γ-干扰素自身抗体、耐多药结核病”同时为检索词均未检索到相关文献。而以“抗γ-干扰素自身抗体、Anti-interferon-γ autoantibodies”分别为中英文关键词在万方数据库、中国知网和PubMed数据库进行检索,共检出抗γ-干扰素自身抗体并发药物敏感结核病2篇,检出抗γ-干扰素自身抗体并发机会性感染61篇,检出抗γ-干扰素自身抗体相关治疗17篇。总结该例患者特征并进行相关文献复习。结果: 该患者经过免疫评估,发现细胞免疫异常、基因突变,因药物不良反应和患者身体一般情况较差,错过最佳治疗时机,未达到理想效果。结合文献研究,65例并发两种及以上机会性感染,50例存在皮肤损害,而抗γ-干扰素自身抗体并发耐多药结核病患者既往无相关文献报道。文献报道中抗γ-干扰素自身抗体阳性的获得性免疫缺陷综合征患者中,机会性感染病原中马尔尼菲篮状菌病71例,非结核分枝杆菌病31例,结核病2例。其中,65例患者并发两种及以上机会性感染,50例患者存在皮肤损害。结论: 抗γ-干扰素自身抗体阳性患者可能合并多重感染,治疗效果差,尽早应用新型免疫制剂联合相关病原体治疗可能获得更好的预后。

Objective: To report the diagnosis and treatment of a case of multi-drug resistant tuberculosis complicated with multiple infections such as marneffei caused by positive anti interferon gamma auto-antibody, and analyzes the clinical characteristics, laboratory examination, treatment and prognosis of the disease combined with literature. Methods: The study retrospectively analyzed the clinical data of a case of multi-drug resistant tuberculosis complicated with multiple infections such as marneffei caused by positive anti interferon gamma auto-antibodies admitted to Beijing Chest Hospital affiliated to Capital Medical University on August 2, 2023. The search deadline is May 31, 2024. The relevant literature was not retrieved from PubMed database with “Anti interferon-γ auto-antibodies, Multi-drug resistant tuberculosis” as the search term, Wanfang database and CNKI database with “Anti-interferon-γ auto-antibodies, multi drug resistant tuberculosis” as the search term. However, “anti interferon gamma auto-antibodies and anti interferon gamma auto-antibodies” were detected in Wanfang database, CNKI and PubMed database respectively, and two anti interferon gamma auto-antibodies were detected with drug sensitive tuberculosis, 61 anti interferon gamma auto-antibodies were detected with opportunistic infection, and 17 anti-interferon-γ auto-antibodies were detected with related treatment. Summarize the patient’s characteristics and conduct relevant literature review. Results: After immune evaluation, the patient was found to have abnormal cellular immunity and gene mutations. Due to adverse drug reactions and poor general physical condition, the best treatment opportunity was missed and the desired effect was not achieved. According to literature research, 65 cases were complicated with two or more opportunistic infections, 50 cases had skin damage, and there was no previous literature report on anti-interferon-γ auto-antibodies complicated with multi-drug resistant tuberculosis. In the acquired immunodeficiency syndrome patients with positive anti-interferon-γ auto-antibodies reported in the literature, 71 cases of Marneffei’s basket shaped mycosis, 31 cases of non-tuberculous mycobacterial disease, and 2 cases of tuberculosis were opportunistic infection pathogens. Among them, 65 patients developed two or more opportunistic infections, and 50 patients had skin damage. Conclusion: Patients with positive anti-interferon-γ auto-antibodies may have multiple infections and poor treatment outcomes. Early use of new immune preparations combined with targeted treatment for related pathogens may achieve better prognosis.