成人急性假膜性坏死性气管支气管炎1例  

A case of acute pseudomembranous necrotizing tracheobronchitis in an adult

作　　者：尚圣云 李新鹏 徐晶 李玉[2] 曹丽群 叶红 Shang Shengyun;Li Xinpeng;Xu Jing;Li Yu;Cao Liqun;Ye Hong(Department of Respiratory and Critical Care Medicine,Qilu Hospital of Shandong University Dezhou Hospital,Dezhou 253000,China;Department of Respiratory and Critical Care Medicine,Qilu Hospital of Shandong University,Jinan 250000,China;Pathology Department,Qilu Hospital of Shandong University Dezhou Hospital,Dezhou 253000,China)

机构地区：[1]山东大学齐鲁医院德州医院呼吸与危重症医学科,德州253000 [2]山东大学齐鲁医院呼吸与危重症医学科,济南250000 [3]山东大学齐鲁医院德州医院病理科,德州253000

出　　处：《中华结核和呼吸杂志》2025年第4期385-388,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：本文报道1例乙型流感病毒继发金黄色葡萄球菌(金葡菌)感染导致气道弥漫损伤的病例,起初患者因药物止血效果差行支气管动脉栓塞治疗,术后未再咯血,但低氧血症持续存在,支气管镜检查见气道黏膜弥漫覆盖黄色脓性假膜,部分黏膜糜烂坏死,肺泡灌洗液宏基因组二代测序(mNGS)检测出潘顿-瓦伦丁白细胞杀伤素(PVL)阳性金葡菌,组织病理示重度急性炎性改变,最终确诊为乙型流感病毒继发金葡菌感染引起急性假膜性坏死性气管支气管炎和出血性肺炎,利奈唑胺治疗好转后,行支气管镜随访,气道内出现多个肉芽组织并逐个清除,排除感染后,口服低剂量泼尼松治疗后痊愈。This study presented a rare case of secondary Staphylococcus aureus(S.aureus)infection following influenza B virus infection,resulting in diffuse airway injury and hemorrhagic pneumonia.The patient initially underwent bronchial artery embolization(BAE)due to persistent hemoptysis refractory to conventional hemostatic therapy.Although the hemoptysis was resolved postoperatively,severe hypoxemia persisted.Bronchoscopy revealed diffuse yellow plaques with mucosal erosion and necrosis in the airways.Metagenomic next-generation sequencing(mNGS)of bronchoalveolar lavage fluid identified S.aureus harboring the Panton-Valentine leukocidin(PVL)genes.Histopathological examination revealed severe acute inflammatory changes consistent with necrotizing airway pathology.A diagnosis of IBV-associated S.aureus infection leading to acute pseudomembranous necrotizing tracheobronchitis and hemorrhagic pneumonia was made.The patient responded favorably to linezolid therapy.Follow-up bronchoscopy revealed multiple granulation tissues in the airways,which were subsequently removed under endoscopic guidance.After ruling out persistent infection,the patient was treated with low-dose oral prednisone,which resulted in significant clinical improvement.

关 键 词：成人 急性假膜性坏死性气管支气管炎 

分 类 号：R563[医药卫生—呼吸系统]