Acute fibrinous and organizing pneumonia associated with influenza A/H1N1 pneumonia after lung transplantation.
Acute fibrinous and organizing pneumonia associated with influenza A/H1N1 pneumonia after lung transplantation.
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DOI：
10.1186/1471-2466-13-30
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发表时间：
2013-05-19
影响因子：
3.1
通讯作者：
Kayser G
中科院分区：
文献类型：
--
作者：
Otto C;Huzly D;Kemna L;Hüttel A;Benk C;Rieg S;Ploenes T;Werner M;Kayser G
免疫功能低下的患者，特别是肺移植后，患上包括甲型H1N1流感在内的非典型肺部感染的风险很高。急性纤维性和机化性肺炎(AFOP)是急性呼吸衰竭的一种特殊组织学类型，病死率高。我们报告一位66岁女性，于2009年8月因终末期肺纤维化而行双肺移植。经过长时间的脱机和随后的有希望的疗程，她于2010年1月患上了非典型肺炎，双肺弥漫性肺浸润性病变。证实感染了甲型H1N1流感病毒。患者很快出现呼吸功能不全，并在确诊后8天死亡。尸检显示，特别是在肺的下部，纯性AFOP的经典组织学模式。肺组织的分子分析对甲型H1N1流感呈阳性。据我们所知，我们报告了首例由病毒感染引发的AFOP病例，这里被证明是甲型H1N1流感病毒。因此，在病毒感染的情况下，也必须考虑AFOP的高度致命性鉴别诊断。
Immunocompromised patients, particularly after lung transplantation, are at high risk to develop atypical forms of pulmonary infections including influenza A/H1N1. Acute Fibrinous and Organizing Pneumonia (AFOP) is a special histological pattern in acute respiratory failure with high mortality. We describe a 66-year-old woman with double lung transplantation in August 2009 due to end stage pulmonary fibrosis. After prolonged weaning and subsequent promising course, she developed atypical pneumonia with diffuse pulmonary infiltrates in both lungs in January 2010. Infection with influenza A/H1N1 virus was verified. The patient rapidly suffered from respiratory insufficiency and died eight days after this diagnosis. The post-mortem revealed especially in the lower parts of the lungs the classical histological pattern of pure AFOP. Molecular analyses of lung tissue were positive for influenza A/H1N1. To our knowledge we present the first case of AFOP triggered by viral infection, here proven to be influenza virus A/H1N1. Thus, also in the setting of viral infection the highly deadly differential diagnosis of AFOP must be considered.
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