肾病综合征患者免疫抑制治疗继发侵袭性肺曲霉病1例  

Invasive pulmonary aspergillosis secondary to immunosuppressive therapy in nephrotic syndrome:a case report

作　　者：阮怡霖 徐天[1] 冯晓蓓[1] 徐静[1] 史浩[1] 任红[1] RUAN Yilin;XU Tian;FENG Xiaobei;XU Jing;SHI Hao;REN Hong(Department of Nephrology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院肾内科,上海200025

出　　处：《内科理论与实践》2024年第5期318-321,共4页Journal of Internal Medicine Concepts & Practice

摘　　要：61岁男性,膜性肾病病史1年余,接受糖皮质激素联合利妥昔单抗治疗。治疗第12天出现高热,伴轻微咳嗽、盗汗,胸部CT示双肺多发结节及斑片影。支气管镜肺泡灌洗液(bronchoalveolar lavage fluid, BALF)行二代测序(next-generation sequencing, NGS)检测提示曲霉菌感染;连续两次G试验阳性,临床拟诊为侵袭性肺曲霉病。经伏立康唑静脉滴注抗真菌治疗6个月,胸部CT复查提示病灶明显吸收,肾病综合征部分缓解,患者恢复良好。A 61⁃year⁃old male with a one⁃year history of membranous nephropathy was placed on combined therapy of glucocorticoids and rituximab.On the 12th day of treatment,the patient developed high fever,accompanied by mild cough and night sweats.Chest CT revealed multiple nodules and patchy opacities in both lungs.Bronchoalveolar lavage fluid(BALF)analysis using next⁃generation sequencing(NGS)identifed Aspergillus infection,and two consecutiveβ⁃D⁃glucan tests were positive.The clinical diagnosis of invasive pulmonary aspergillosis(IPA)was established.The patient received intravenous voriconazole for six months.Follow⁃up chest CT showed significant absorption of pulmonary lesions.The treatment regimen led to recovery of the patient and achieved partial remission of nephrotic.

关 键 词：膜性肾病 侵袭性肺曲霉病 免疫抑制治疗 利妥昔单抗 二代测序 

分 类 号：R692[医药卫生—泌尿科学]