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1例60岁系统性红斑狼疮女性患者,初始服用甲泼尼龙40mg,1次/d,用甲泼尼龙治疗45d后加用吗替麦考酚酯0.75g,2次/d,用药38d后出现发热、胸闷、低氧血症。X线胸片示双肺纹理增多模糊,双肺野呈磨玻璃样。给予哌拉西林-三唑巴坦钠和莫西沙星抗感染治疗,效果欠佳。实验室检测示CD4+T淋巴细胞亚群计数为103/mm3,支气管肺泡灌洗液检出伊氏肺孢子菌,确诊为肺孢子虫肺炎。遂将吗替麦考酚酯减量至0.5g,并给予卡泊芬净50mg/d,联磺甲氧苄胺2片,4次/d,用药第5天患者胸闷、呼吸困难好转。
A case of 60-year-old female patients with systemic lupus erythematosus, initially taking methylprednisolone 40mg, 1 / d, with methylprednisolone 45d after treatment with mycophenolate mofetil 0.75g, 2 times / d, after 38d appeared Fever, chest tightness, hypoxemia. X-ray showed double lung texture increased blur, lung field was ground glass-like. Given piperacillin - tazobactam sodium and moxifloxacin anti-infective treatment, the effect is not good. Laboratory tests showed CD4 + T lymphocyte subsets count was 103 / mm3, bronchial alveolar lavage fluid detection of Pneumocystis carinii, diagnosed as pneumocystis pneumonia. Will then reduce mycophenolate mofetil to 0.5g, and given caspofungin net 50mg / d, methotrexate 2, 4 times / d, medication on the 5th day patients with chest tightness, breathing difficulties improved.