BACKGROUND Nontuberculous mycobacterium(NTM) refers to all mycobacteria except Mycobacterium tuberculosis and Mycobacterium leprae, also known as environmental Mycobacterium. The patients with lung cancer and NTM are ...BACKGROUND Nontuberculous mycobacterium(NTM) refers to all mycobacteria except Mycobacterium tuberculosis and Mycobacterium leprae, also known as environmental Mycobacterium. The patients with lung cancer and NTM are somewhat special;the two diseases are inevitably influenced by each other. It brings difficulties and challenges to the choice of treatment. Recently, cancer immunotherapy has been considered one of the pillars for the treatment of lung cancer. However, the clinical experience in the application of immune checkpoint inhibitors is scarce for lung cancer patients with pulmonary tuberculosis, and lung cancer with NTM is even more rare. Although it ameliorates lung cancer, immunotherapy with immune checkpoint inhibitors presents complications of infectious diseases, including tuberculosis and NTM.CASE SUMMARY A 61-year-old male patient visited a doctor in May 2019. His admitting diagnoses were:(1) Cancer of the left lung with a pathological diagnosis of poorly differentiated non-small cell carcinoma, likely poorly differentiated adenocarcinoma, clinical stage Ⅲb(T3N3M0);and(2) Mycobacterium fortuitum(M. fortuitum) infection. We chose to proceed with pembrolizumab treatment. After two treatment cycles, a chest computed tomography scan showed a new irregular subpleural mass in the anterior segment of the left upper lobe of the lung, a reduction in the mediastinal enlarged lymph node, and no other obvious changes. Next, an ultrasound-guided biopsy of the new tumor was performed. Pathological examination showed that a large number of carbon particles were deposited in the alveolar tissue with histiocyte reaction and multinucleated giant cell formation. The tuberculosis(TB) specialist suggested that anti-TB therapy be combined with continued antitumor treatment. The patient continued to be treated with pembrolizumab. After 14 cycles, the lesion shrunk by 79%, there was no recurrence of M. fortuitum infection, and there were no intolerable adverse reactions.CONCLUSION We have observed that in cases of lung cancer complicated with M. fortuitum infection, opportunistic pathogen infection recurrence can be overcome, and immunotherapy is most beneficial when TB doctors and oncologists cooperate to closely observe dynamic changes in M. fortuitum and lung cancer. Treatment should be maintained with low dosage anti-TB drugs after general anti-TB chemotherapy for 1 year;this may prevent opportunistic pathogen infection recurrence during immunotherapy.展开更多
Granulomatous lobular mastitis is a rare inflammatory disease of the breast of unknown etiology. Most present as breast masses in women of child-bearing age. A 29-year-old female presented with a swollen, firm and ten...Granulomatous lobular mastitis is a rare inflammatory disease of the breast of unknown etiology. Most present as breast masses in women of child-bearing age. A 29-year-old female presented with a swollen, firm and tender right breast, initially misdiagnosed as mastitis. Core needle biopsy revealed findings consistent with granulomatous lobular mastitis, and cultures were all negative for an infectious etiology. She was started on steroid therapy to which she initially responded well. A few weeks later she deteriorated and was found to have multiple breast abscesses. She underwent operative drainage and cultures grew Mycobacterium fortuitum. Granulomatous lobular mastitis is a rare inflammatory disease of the breast. The definitive diagnose entails a biopsy. Other causes of chronic or granulomatous mastitis should be ruled out, including atypical or rare bacteria such as Mycobacterium fortuitum. This is the first reported case of granulomatous mastitis secondary to Mycobacterium fortuitum. With pathologic confirmation of granulomatous mastitis, an infectious etiology must be ruled out. Atypical bacteria such as Mycobacterium fortuitum may not readily grow on cultures, as with our case. Medical management is appropriate, with surgical excision reserved for refractory cases or for drainage of abscesses.展开更多
目的分析临床药师参与1例腹股沟疝修补术后切口感染偶发分枝杆菌患者的治疗方案及药学监护过程。方法经临床药学、检验科、院感办等多学科会诊后考虑偶发分枝杆菌感染,临床药师查询循证医学证据,协助医生制定及调整偶发分枝杆菌抗感染方...目的分析临床药师参与1例腹股沟疝修补术后切口感染偶发分枝杆菌患者的治疗方案及药学监护过程。方法经临床药学、检验科、院感办等多学科会诊后考虑偶发分枝杆菌感染,临床药师查询循证医学证据,协助医生制定及调整偶发分枝杆菌抗感染方案,并针对长疗程联合使用的抗菌药物进行疗效、不良反应及院外随访等药学监护。结果临床药师首次会诊予以阿米卡星注射液0.6 g qd(维持剂量0.4 g)+莫西沙星氯化钠注射液0.4 g qd+亚胺培南西司他丁1 g q12h+多西环素注射液0.1 g q12h(首剂0.2 g)抗感染治疗,后续根据药品不良反应及循证学证据对方案进行优化调整,患者好转出院。结论临床药师参与抗感染多学科会诊,通过查阅循证医学证据,协助医生制定抗感染方案及实施全程药学监护,不仅能提高患者治疗效果,还有助于提升临床药师抗感染会诊水平。展开更多
Pleural effusion is a commonly encountered respiratory disorder. In the majority of cases, a single causative agent is responsible. Pleural effusions resulting from simultaneous involvement of the membranes by two dif...Pleural effusion is a commonly encountered respiratory disorder. In the majority of cases, a single causative agent is responsible. Pleural effusions resulting from simultaneous involvement of the membranes by two different pathologic processes are unusual.展开更多
文摘BACKGROUND Nontuberculous mycobacterium(NTM) refers to all mycobacteria except Mycobacterium tuberculosis and Mycobacterium leprae, also known as environmental Mycobacterium. The patients with lung cancer and NTM are somewhat special;the two diseases are inevitably influenced by each other. It brings difficulties and challenges to the choice of treatment. Recently, cancer immunotherapy has been considered one of the pillars for the treatment of lung cancer. However, the clinical experience in the application of immune checkpoint inhibitors is scarce for lung cancer patients with pulmonary tuberculosis, and lung cancer with NTM is even more rare. Although it ameliorates lung cancer, immunotherapy with immune checkpoint inhibitors presents complications of infectious diseases, including tuberculosis and NTM.CASE SUMMARY A 61-year-old male patient visited a doctor in May 2019. His admitting diagnoses were:(1) Cancer of the left lung with a pathological diagnosis of poorly differentiated non-small cell carcinoma, likely poorly differentiated adenocarcinoma, clinical stage Ⅲb(T3N3M0);and(2) Mycobacterium fortuitum(M. fortuitum) infection. We chose to proceed with pembrolizumab treatment. After two treatment cycles, a chest computed tomography scan showed a new irregular subpleural mass in the anterior segment of the left upper lobe of the lung, a reduction in the mediastinal enlarged lymph node, and no other obvious changes. Next, an ultrasound-guided biopsy of the new tumor was performed. Pathological examination showed that a large number of carbon particles were deposited in the alveolar tissue with histiocyte reaction and multinucleated giant cell formation. The tuberculosis(TB) specialist suggested that anti-TB therapy be combined with continued antitumor treatment. The patient continued to be treated with pembrolizumab. After 14 cycles, the lesion shrunk by 79%, there was no recurrence of M. fortuitum infection, and there were no intolerable adverse reactions.CONCLUSION We have observed that in cases of lung cancer complicated with M. fortuitum infection, opportunistic pathogen infection recurrence can be overcome, and immunotherapy is most beneficial when TB doctors and oncologists cooperate to closely observe dynamic changes in M. fortuitum and lung cancer. Treatment should be maintained with low dosage anti-TB drugs after general anti-TB chemotherapy for 1 year;this may prevent opportunistic pathogen infection recurrence during immunotherapy.
文摘Granulomatous lobular mastitis is a rare inflammatory disease of the breast of unknown etiology. Most present as breast masses in women of child-bearing age. A 29-year-old female presented with a swollen, firm and tender right breast, initially misdiagnosed as mastitis. Core needle biopsy revealed findings consistent with granulomatous lobular mastitis, and cultures were all negative for an infectious etiology. She was started on steroid therapy to which she initially responded well. A few weeks later she deteriorated and was found to have multiple breast abscesses. She underwent operative drainage and cultures grew Mycobacterium fortuitum. Granulomatous lobular mastitis is a rare inflammatory disease of the breast. The definitive diagnose entails a biopsy. Other causes of chronic or granulomatous mastitis should be ruled out, including atypical or rare bacteria such as Mycobacterium fortuitum. This is the first reported case of granulomatous mastitis secondary to Mycobacterium fortuitum. With pathologic confirmation of granulomatous mastitis, an infectious etiology must be ruled out. Atypical bacteria such as Mycobacterium fortuitum may not readily grow on cultures, as with our case. Medical management is appropriate, with surgical excision reserved for refractory cases or for drainage of abscesses.
文摘目的分析临床药师参与1例腹股沟疝修补术后切口感染偶发分枝杆菌患者的治疗方案及药学监护过程。方法经临床药学、检验科、院感办等多学科会诊后考虑偶发分枝杆菌感染,临床药师查询循证医学证据,协助医生制定及调整偶发分枝杆菌抗感染方案,并针对长疗程联合使用的抗菌药物进行疗效、不良反应及院外随访等药学监护。结果临床药师首次会诊予以阿米卡星注射液0.6 g qd(维持剂量0.4 g)+莫西沙星氯化钠注射液0.4 g qd+亚胺培南西司他丁1 g q12h+多西环素注射液0.1 g q12h(首剂0.2 g)抗感染治疗,后续根据药品不良反应及循证学证据对方案进行优化调整,患者好转出院。结论临床药师参与抗感染多学科会诊,通过查阅循证医学证据,协助医生制定抗感染方案及实施全程药学监护,不仅能提高患者治疗效果,还有助于提升临床药师抗感染会诊水平。
文摘Pleural effusion is a commonly encountered respiratory disorder. In the majority of cases, a single causative agent is responsible. Pleural effusions resulting from simultaneous involvement of the membranes by two different pathologic processes are unusual.
