呼吸困难伴双肺多发阴影  

Dyspnea with multiple bilateral lung opacities on CT scan

作　　者：李世家 马秀红 尹志洋 冯秋月 田占红 王红梅 方秋红[4] Li Shijia;Ma Xiuhong;Yin Zhiyang;Feng Qiuyue;Tian Zhanhong;Wang Hongmei;Fang Qiuhong(Department of Pulmonary and Critical Care Medicine,Beijing Huairou Hospital,Beijing 101400,China;Department of Infectious Disease,Beijing Huairou Hospital,Beijing 101400,China;Department of Pathology,Beijing Huairou Hospital,Beijing 101400,China;Department of Pulmonary and Critical Care Medicine,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]北京怀柔医院呼吸与危重症医学科,北京101400 [2]北京怀柔医院感染疾病科,北京101400 [3]北京怀柔医院病理科,北京101400 [4]首都医科大学附属北京朝阳医院呼吸与危重症医学科,北京100020

出　　处：《中华结核和呼吸杂志》2024年第8期761-766,共6页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：本文报道了1例58岁男性患者,以急性左心功能不全表现就诊,但抗心力衰竭治疗效果不理想。入院后监测到持续发热、影像学进展,支气管肺泡灌洗液检出贝纳特柯克斯体,肺组织病理提示机化性肺炎。患者饲养家兔,发病前曾给孕兔接生,部分幼兔生后死亡,综合考虑为Q热肺炎继发机化性肺炎。针对Q热肺炎抗感染治疗后患者体温正常,进一步加用糖皮质激素治疗,患者症状缓解且肺部阴影吸收。最终明确诊断为Q热肺炎继发机化性肺炎合并心功能不全。A 58-year-old man was admitted with a typical presentation of acute left heart failure.However,the patient showed a partial response to the anti-heart failure therapy.Following admission,a continuous fever was monitored,and a CT scan revealed that multiple opacities on bilateral lungs had progressed.Bronchoscopy was performed,and Coxiella burnetii was detected by Metagenomic next-generation sequencing(mNGS)in bronchoalveolar lavage(BALF),and transbronchial lung biopsy showed organizing pneumonia.Considering that the patient had a history of rabbit breeding and delivery,with some newborn rabbits dying before he became ill,organizing pneumonia secondary to Q fever pneumonia was diagnosed.Anti-Q fever treatment was initiated and the patient′s temperature returned to normal.Glucocorticoid was administered after adequate treatment for Q fever.The patient′s symptom of dyspnea relieved soon and opacities on CT scan were absorbed remarkably.The final diagnosis was organizing pneumonia secondary to Q fever pneumonia accompanied with left heart failure.

关 键 词：贝纳特柯克斯体 Q热 肺炎 机化性肺炎 

分 类 号：R563.1[医药卫生—呼吸系统]