肾病综合征患者免疫抑制治疗继发侵袭性肺曲霉病1例

doi:10.16138/j.1673-6087.2024.05.06

摘要/Abstract

摘要：

61岁男性，膜性肾病病史1年余，接受糖皮质激素联合利妥昔单抗治疗。治疗第12天出现高热，伴轻微咳嗽、盗汗，胸部CT示双肺多发结节及斑片影。支气管镜肺泡灌洗液（bronchoalveolar lavage fluid， BALF）行二代测序（next-generation sequencing， NGS）检测提示曲霉菌感染；连续两次G试验阳性，临床拟诊为侵袭性肺曲霉病。经伏立康唑静脉滴注抗真菌治疗6个月，胸部CT复查提示病灶明显吸收，肾病综合征部分缓解，患者恢复良好。

关键词: 膜性肾病, 侵袭性肺曲霉病, 免疫抑制治疗, 利妥昔单抗, 二代测序

Abstract:

A 61-year-old male with a one-year history of membranous nephropathy was placed on combined therapy of glucocorticoids and rituximab. On the 12th day of treatment, the patient developed high fever, accompanied by mild cough and night sweats. Chest CT revealed multiple nodules and patchy opacities in both lungs. Bronchoalveolar lavage fluid (BALF) analysis using next-generation sequencing (NGS) identifed Aspergillus infection, and two consecutive β-D-glucan tests were positive. The clinical diagnosis of invasive pulmonary aspergillosis (IPA) was established. The patient received intravenous voriconazole for six months. Follow-up chest CT showed significant absorption of pulmonary lesions. The treatment regimen led to recovery of the patient and achieved partial remission of nephrotic.

Key words: Membranous nephropathy, Invasive pulmonary aspergillosis, Immunosuppressive therapy, Rituximab, Next-generation sequencing

中图分类号:

R692

阮怡霖, 徐天, 冯晓蓓, 徐静, 史浩, 任红. 肾病综合征患者免疫抑制治疗继发侵袭性肺曲霉病1例[J]. 内科理论与实践, 2024, 19(05): 318-321.

RUAN Yilin, XU Tian, FENG Xiaobei, XU Jing, SHI Hao, REN Hong. Invasive pulmonary aspergillosis secondary to immunosuppressive therapy in nephrotic syndrome: a case report[J]. Journal of Internal Medicine Concepts & Practice, 2024, 19(05): 318-321.

图/表 2

参考文献 19

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时间	（1-3）-β-D葡聚糖（pg/mL）	降钙素原（ng/mL）	蛋白尿定量（mg/24h）	肌酐（μmol/L）
2022年9月	9.99	0.12	13 810	131
2022年10月
入院第1天	560.20	0.23	5 829	117
入院第7天	208.77	0.22	4 520	113
入院第17天	56.04	—	4 531	115
2023年6月	9.99	0.04	4 096	135
2023年8月	9.99	0.04	3 309	141