AIDS合并惠普尔养障体肺炎及皮肤结核1例报道

doi:10.19871/j.cnki.xfcrbzz.2025.04.012

摘要/Abstract

摘要： 本文报道1例55岁女性AIDS合并惠普尔养障体肺炎和皮肤结核的罕见病例。患者因腹痛、发热和咳嗽入院,既往有HIV感染并接受抗反转录病毒治疗。实验室检查显示外周血中性粒细胞、C反应蛋白升高,胸部CT提示两肺结节影。初期诊断为细菌性肺炎,予头孢吡肟治疗,效果不佳。后通过纳米孔测序技术在支气管肺泡灌洗液中检出惠普尔养障体序列,改用复方磺胺甲唑片抗感染后,患者体温下降,呼吸道症状好转。同时,患者右下肢出现皮疹,病理检查提示结核性肉芽肿性炎症改变,结合结核相关γ干扰素释放试验阳性,诊断为皮肤结核。予标准抗结核治疗,并调整抗病毒方案。患者症状改善后出院,继续接受抗结核和抗HIV治疗。本文强调惠普尔养障体可导致肺部感染,确诊需依赖临床表现、组织病理学检查及分子生物学检测,纳米孔测序技术可快速准确诊断。皮肤结核作为结核病的一种罕见形式,诊断主要依据皮肤病理组织检查,治疗需要长期联合用药。本病例展示了在HIV感染者中,罕见病原体感染的诊治挑战,以及纳米孔测序技术在快速诊断中的应用价值,旨在为临床医师应对此类复杂感染病例提供实用的诊疗参考依据。

关键词: 获得性免疫缺陷综合征, 惠普尔养障体肺炎, 皮肤结核, 纳米孔测序

Abstract: This article reports a rare case of a 55-year-old female patient with AIDS complicated by tropheryma whipplei pneumonia and cutaneous tuberculosis. The patient was admitted to the hospital due to abdominal pain, fever, and cough. She had a history of HIV infection and had been receiving antiretroviral therapy. Laboratory tests showed elevated peripheral blood neutrophil count and CRP levels, and chest CT revealed nodular shadows in both lungs. Initially, she was diagnosed with bacterial pneumonia and treated with cefepime, but the treatment was ineffective. Subsequently, tropheryma whipplei sequences were detected in the bronchoalveolar lavage fluid through nanopore sequencing technology. After switching to trimethoprim-sulfamethoxazole for anti-infection treatment, the patient's body temperature decreased, and her respiratory symptoms improved. Meanwhile, a rash appeared on the patient's right lower limb. Pathological examination suggested granulomatous inflammation due to tuberculosis, and the diagnosis of cutaneous tuberculosis was confirmed in combination with a positive interferon-gamma release assay for tuberculosis. The patient was then treated with standard anti-tuberculosis therapy and her antiviral regimen was adjusted. The patient was discharged after her symptoms improved and continued to receive anti-tuberculosis and anti-AIDS treatment. This article emphasizes that tropheryma whipplei can cause pulmonary infections, and the diagnosis relies on clinical manifestations, histopathological examination, and molecular biological detection. Nanopore sequencing technology can provide rapid and accurate diagnosis. Cutaneous tuberculosis, a rare form of tuberculosis, is mainly diagnosed based on skin histopathological examination and requires long-term combination therapy. This case highlights the diagnostic and therapeutic challenges of infections caused by rare pathogens in HIV-infected individuals and the utility of nanopore sequencing technology in rapid diagnosis. It aims to provide practical diagnostic and therapeutic references for clinicians dealing with such complex infectious cases.

Key words: Acquired immune deficiency syndrome, Tropheryma whipplei pneumonia, Cutaneous tuberculosis, Nanopore sequencing

中图分类号:

赵春艳, 宋畅, 黄爱春, 许超艳, 曾春梅, 朱庆东. AIDS合并惠普尔养障体肺炎及皮肤结核1例报道[J]. 新发传染病电子杂志, 2025, 10(4): 71-75.

Zhao Chunyan, Song Chang, Huang Aichun, Xu Chaoyan, Zeng Chunmei, Zhu Qingdong. A case of AIDS combined with tropheryma whipplei pneumonia and cutaneous tuberculosis was reported[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(4): 71-75.

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