慢加急性肝衰竭合并非典型耶氏肺孢子菌肺炎1例

作者：王文浩  王怡恺  潘国英  党双锁  贾晓黎  石娟娟

单位：西安交通大学第二附属医院 感染科 陕西 西安 710004

关键词：肝衰竭 慢加急性 肺孢子菌肺炎 发热

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出版年,卷(期):页码：2025,17(4):63-67

摘要：

摘要：本文报道1例以乏力、食欲不振、发热伴皮疹为主要表现的慢加急性肝衰竭合 并非典型耶氏肺孢子菌肺炎（Pneumocystis jirovecii pneumonia，PJP）患者，因停用恩 替卡韦6个月导致慢加急性肝衰竭，病情好转后出现发热伴皮疹病因不明，由于肺部感 染病灶表现不典型，最终通过宏基因组新一代测序技术（metagenomics next generation sequencing，mNGS）于支气管肺泡灌洗液（broncho alveolar lavage fluid，BALF）中检 出耶氏肺孢子菌，确诊PJP，经治疗后病情好转。PJP主要发生于免疫功能低下人群， 慢加急性肝衰竭合并非典型PJP较为罕见，预后较差，死亡率高。本文总结诊治经验并 回顾相关文献，以期为临床提供参考。

Abstract: A case of acute-on-chronic liver failure complicated with atypical Pneumocystis jirovecii pneumonia (PJP) with the main manifestations of fatigue, loss of appetite, fever and rash was reported in this paper. The patient developed ACLF due to discontinuation of entecavir for 6 months; after the condition improved, fever accompanied by rash occurred with unknown etiology. Due to the atypical manifestations of pulmonary infection lesions, Pneumocystis jirovecii was finally detected in broncho alveolar lavage fluid (BALF) via metagenomic next generation sequencing (mNGS), leading to a confirmed diagnosis of PJP. The patient’s condition improved following targeted treatment. PJP primarily affected immunocompromised populations. The combination of acute-on-chronic liver failure and atypical PJP was relatively rare, characterized by poor prognosis and high mortality rate. This article summarized the diagnosis and treatment experience and reviewed relevant literature, aiming to provide clinical references.

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