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患者,男,47岁。主因发热伴咽痛、干咳3 d,于2006年6月24日人院。患者于2006年3月28日在本院行同种异体肾移植术,术后给予微乳化环孢素 A、麦考酚酸酯、泼尼松三联免疫抑制治疗。入院查体:口唇元发绀,肺部呼吸音粗,未闻及干、湿性哕音,心率95次/min,律齐。血肌酐为127μmol/L,乳酸脱氢酶为445 IU。动脉血氧分压为73 mm Hg(1 mm Hg=0.133 kPa),血氧饱和度为96%。入院后给予头孢曲松钠治疗,患者逐渐出现呼吸困难,于2006年6月29日行纤维支气管镜肺泡灌洗,胸部 CT 示弥漫性磨砂玻璃样改变并伴少量纵隔气肿(图1)。2006年6月30日支气管肺泡灌洗液检查找到肺孢子菌(pneumocystis,PC)菌体确诊(图2),即行抗肺孢子菌治疗:复方磺胺甲噁唑(SMZ 100
Patient, male, 47 years old. Mainly due to fever and sore throat, dry cough 3 d, on June 24, 2006 hospital. All patients underwent renal allograft transplantation in our hospital on March 28, 2006 and were treated with micro-emulsified cyclosporine A, mycophenolate mofetil and prednisone triple immunosuppressive therapy. Admission examination: lip cyanosis, pulmonary breath sounds rough, unheard of and dry, wet 哕 sound, heart rate 95 beats / min, law Qi. Serum creatinine was 127 μmol / L and lactate dehydrogenase was 445 IU. Arterial oxygen partial pressure of 73 mm Hg (1 mm Hg = 0.133 kPa), oxygen saturation of 96%. After admission to give ceftriaxone sodium treatment, patients gradually breathing difficulties, on June 29, 2006 underwent bronchofulmonary lavage, chest CT showed diffuse frosted glass-like changes with a small amount of mediastinal emphysema (Figure 1). On June 30, 2006, bronchoalveolar lavage fluid examination was performed to confirm the presence of pneumocystis (PC) cells (Figure 2)