| Autor: |
Nureki SI; Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine., Usagawa Y; Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine., Watanabe E; Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine., Takenaka R; Department of Emergency Medicine, Oita University Faculty of Medicine., Shigemitsu O; Department of Emergency Medicine, Oita University Faculty of Medicine., Abe T; Department of Anesthesiology and Intensive Care Medicine, Oita University Faculty of Medicine., Yasuda N; Department of Anesthesiology and Intensive Care Medicine, Oita University Faculty of Medicine., Goto K; Department of Anesthesiology and Intensive Care Medicine, Oita University Faculty of Medicine., Kitano T; Department of Anesthesiology and Intensive Care Medicine, Oita University Faculty of Medicine., Kadota JI; Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine. |
| Jazyk: |
angličtina |
| Zdroj: |
The Tohoku journal of experimental medicine [Tohoku J Exp Med] 2020 Apr; Vol. 250 (4), pp. 215-221. |
| DOI: |
10.1620/tjem.250.215 |
| Abstrakt: |
Pneumocystis jirovecii pneumonia (PJP) occurs in immunocompromised hosts and is classified as PJP with human immunodeficiency virus (HIV) infection (HIV-PJP) and PJP without HIV infection (non-HIV PJP). Non-HIV PJP rapidly progresses to respiratory failure compared with HIV-PJP possibly due to the difference in immune conditions; namely, the prognosis of non-HIV PJP is worse than that of HIV PJP. However, the diagnosis of non-HIV PJP at the early stage is difficult. Herein, we report a case of severe non-HIV PJP successfully managed with veno-venous extracorporeal membrane oxygenation (V-V ECMO). A 54-year-old woman with neuromyelitis optica was treated with oral corticosteroid, azathioprine, and methotrexate. She admitted to our hospital for fever, dry cough, and dyspnea which developed a week ago. On admission, she required endotracheal intubation and invasive ventilation for hypoxia. A chest computed tomography (CT) scan revealed ground-glass opacity and consolidation in the both lungs. Grocott staining and PCR analysis of bronchoalveolar lavage fluid indicated the presence of fungi and Pneumocystis jirovecii, respectively, whereas serum HIV-antibody was negative. The patient was thus diagnosed with non-HIV PJP and was treated with intravenous pentamidine and corticosteroid pulse therapy for PJP. However, hypoxia was worsened; consequently, V-V ECMO assistance was initiated on day 7. The abnormal chest CT findings and hypoxia were gradually improved. The V-V ECMO support was successfully discontinued on day 14 and mechanical ventilation was discontinued on day 15. V-V ECMO could be a useful choice for respiratory assistance in severe cases of PJP among patients without HIV infection. |
| Databáze: |
MEDLINE |
| Externí odkaz: |
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