嗜肺军团菌肺炎合并出血性脑白质病与横纹肌溶解症1例  

A case of Legionella pneumophila pneumonia complicated by acute hemorrhagic leukoaraiosis and rhabdomyolysis

作　　者：杨秋月[1] 孟祥林[1] 赵鸣雁[1] 孔卫兰[1] Yang Qiuyue;Meng Xianglin;Zhao Mingyan;Kong Weilan(Department of Critical Care Medicine,the First Affiliated Hospital of Harbin Medical University,Harbin150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院重症医学科,哈尔滨150001

出　　处：《中华结核和呼吸杂志》2025年第2期145-148,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：黑龙江省重点研发计划(GA21C011,JD22C005)。

摘　　要：嗜肺军团菌肺炎合并出血性脑白质病与横纹肌溶解临床罕见,本文报道1例罹患嗜肺军团菌肺炎合并出血性脑白质病与横纹肌溶解的女性患者,其肌酸激酶和肌红蛋白显著升高,头颅CT示脑内多发出血灶,给予抗感染、呼吸支持、液体复苏、血液净化、脑保护、糖皮质激素、免疫球蛋白及对症支持治疗后,患者病情好转痊愈出院。Legionella pneumophila pneumonia complicated by acute hemorrhagic leukoencephalopathy(AHLE)and rhabdomyolysis is an extremely rare clinical entity.This report presents the case of a female patient diagnosed with Legionella pneumophila pneumonia who subsequently developed AHLE and rhabdomyolysis.Laboratory investigations demonstrated markedly elevated creatine kinase and myoglobin levels,and a head CT scan revealed multiple cerebral hemorrhagic lesions.The patient received a multidisciplinary treatment regimen,including anti-infective therapy,respiratory support,fluid resuscitation,blood purification,neuroprotective measures,corticosteroids,immunoglobulin therapy,and symptomatic supportive care.The patient′s condition gradually improved,and she was successfully discharged.This case highlights the need for clinicians to remain vigilant for rare but severe complications associated with Legionella infections and emphasizes the importance of timely,comprehensive management in achieving favorable outcomes.

关 键 词：横纹肌溶解 脑白质病 液体复苏 出血灶 呼吸支持 糖皮质激素 免疫球蛋白 血液净化 

分 类 号：R563.1[医药卫生—呼吸系统] R743.3[医药卫生—内科学] R685.5[医药卫生—临床医学]