艾滋病合并耶氏肺孢子菌肺炎和猴痘1例报道  

A case report of AIDS complicated with PJP and monkeypox

作　　者：杨军妍 苏娜 辛晓丽[2] 陈俞好 梁煊 Yang Junyan;Su Na;Xin Xiaoli;Chen Yuhao;Liang Xuan(Department of Radiology,Shenyang Sixth People's Hospital,Liaoning Shenyang 110006,China;Department of Care Section,Shenyang Sixth People's Hospital,Liaoning Shenyang 110006,China;Department of Radiology,The First Hospital of China Medical University,Liaoning Shenyang 110002,China)

机构地区：[1]沈阳市第六人民医院放射科,辽宁沈阳110006 [2]沈阳市第六人民医院关爱科,辽宁沈阳110006 [3]中国医科大学附属第一医院放射科,辽宁沈阳110002

出　　处：《新发传染病电子杂志》2024年第2期64-67,共4页Electronic Journal of Emerging Infectious Diseases

基　　金：沈阳市新发突发传染病诊断及治疗医学研究中心项目。

摘　　要：猴痘病毒相关肺部感染较罕见,本文报道1例艾滋病合并耶氏肺孢子菌肺炎(pneumocystis jirovecii pneumonia,PJP)同时合并猴痘的病例。该病例系沈阳市第六人民医院2023年10月收治的40岁男性患者,入院前已确诊HIV阳性,周身皮疹伴发热2个月,干咳2周。皮疹局部可见脓性渗出及少量渗血,周围绕以红晕。CD4^(+)T淋巴细胞6.0×10^(6)/L,猴痘病毒核酸检测阳性。肺部影像学检查显示两肺呈弥漫性分布磨玻璃影,肺内见多发大小不等实性结节灶,边缘可见晕征、毛刺等。肺结节穿刺活检,组织病原微生物检测为猴痘病毒及耶氏肺孢子菌阳性。临床给予抗感染、抗真菌及复方新诺明等治疗,患者发热、呼吸困难持续加重,最终死亡。本文通过复习有关资料,深入探讨了艾滋病合并PJP和猴痘时的临床特点及肺部影像学表现,以期提升临床认识。Monkeypox virus (MPXV)-associated pulmonary infection is relatively rare.We report a case of AIDS with pneumocystis jirovecii pneumonia (PJP) and monkeypox.This is a 40-year-old male patient admitted to Shenyang Sixth People's Hospital on October 2023.The patient was diagnosed as HIV positive before admission,with peripheral rash and fever for 2 months,dry cough for 2 weeks.Local exudation of pus and a small amount of bleeding were observed in the rash,surrounded by flush.The absolute count of CD4^(+)T lymphoeytes was 6.0×10^(6)/L,monkeypox virus nucleic acid test was positive.Lung imaging showed diffuse distribution of ground-glass opacity in both lungs,multiple solid nodules with different sizes were observed in the lungs,halo sign and burrs were observed at the edge.Needle biopsy of pulmonary nodules,histopathogenic microorganism test results were positive for monkeypox virus and Pneumocystis jirovecii.The patient was treated with anti-infection,antifungal and cotrimoxazole.Fever and dyspnea continued to worsen,and finally died.In this paper,the clinical features and pulmonary imaging manifestations of HIV co-infection with PJP and monkeypox virus were discussed by reviewing relevant data,in order to improve the understanding.

关 键 词：艾滋病 猴痘 耶氏肺孢子菌 肺部 影像学表现 

分 类 号：R563.1[医药卫生—呼吸系统] R512.91[医药卫生—内科学]