Pneumocystis jirovecii pneumonia in non-HIV-infected patients with acute leukemia after chemotherapy:A case report and literature review
- VernacularTitle:HIV阴性急性白血病患者化疗后并发耶氏肺孢子菌肺炎1例报告及文献复习
- Author:
Wenbin CAO
1
;
Qingzhen LIU
;
Lukun ZHOU
;
Xiaohui ZHENG
;
Shulian CHEN
;
Rongli ZHANG
;
Yi HE
;
Sizhou FENG
;
Mingzhe HAN
;
Donglin YANG
Author Information
1. 中国医学科学院 北京协和医学院血液学研究所 血液病医院造血干细胞移植中心
- Keywords:
acute leukemia;
human immunodefieiency virus;
haematology;
Pneumocystis jirovecii pneumonia;
chemotherapy
- From:
Journal of Jilin University(Medicine Edition)
2019;45(1):148-152
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To discuss the clinical characteristics of the Pneumocystis jirovecii pneumonia (PCP) in the non-HIV-infected blood disease patients, and to analyze its risk factors, treatment methods, prognosis and prevention measures.Methods:A female patient aged 18years old was confirmed as acute myeloid leukemia (AML) , and experienced dyspnea, chest congestion and hypoxaemia during the recovery period of hemogram after chemotherapy.The chest CT showed the bilateral lung diffuse ground glass density images.The patient had a dry cough and the oxygen saturation was gradually decreased to 75％5dafter antibacteriological treatment.A repeat chest CT showed enlarged diffuse ground glass density images on both lungs.Considering about the possibility of PCP, the patient received oral trimethoprim/sulfamethoxazole (TMP/SMX) 1g, once every 6h, in combination with caspofungin.Results:Two days later, the symptoms of the patients were not improved.The patient was transferred to ICU and was diagnosed PCP by bronchoalveolar lavage.The patient was switched to oral TMP/SMX2g, once every 8h, in combination with caspofungin.Meanwhile, the patient received bi-level positive airway pressure ventilation (Bipap) for the increased work of breathing.Five days later, the symptoms of the patients were improved and the Bipap was stopped.The patient got better and discharged 5dlater.The patient continuely received oral TMP/SMX 2g, once every 8hfor 36d.Conclusion:Prevention of PCP should be focused, in the non-HIV-infected blood disease patients receiving chemotherapy.Diagnosis of PCP should be considered in these patients without prevention who once have suspected clinical manifestation of PCP in non-granulocytic phase.Early empirical treatment of PCP and ICU management in the non-HIV-infected blood disease patients with acute respiratory failure are the keys to reduce death and improve the prognosis of PCP.
