綠膿桿菌肺炎引發咳血之案例報告

Hemoptysis Resulting from Pseudomonas aeruginosa Pneumonia- Case Report

綠膿桿菌肺炎是少見的社區型肺炎，好發於免疫力不全或患有重大疾病者，健 康人受感染仍屬少數。初期發燒、膿痰、咳血症狀難與一般肺炎做鑑別，但病程快 速進展常導致呼吸衰竭。本文報告一位 62 歲男性水電工，無慢性病史，歷經數日背 痛、胸痛、咳嗽，痰液夾帶血絲，到醫院就診，胸部 X 光顯示右肺上葉肺炎，給予 經驗性抗生素治療，次日大量咳血及呼吸困難，電腦斷層檢查，發現右肺上葉大片 空洞壞死及雙側肺實質病變。因病情持續惡化，而進行胸腔鏡右肺上葉切除手術， 術後順利出院。藉由本個案強化醫療人員對症狀敏感度，若肺炎病人出現咳血情 形，需高度懷疑綠膿桿菌感染導致之壞死性肺炎，確定診斷後，抗生素使用，及早 採取外科手術介入，增加治癒率。

 

Pseudomonas aeruginosa pneumonia is a rare community-acquired pneumonia, which usually occurs in immunocompromised and chronically ill patients, and rarely in healthy ones. The early symptoms are fever, purulent sputum, and hemoptysis, making it difficult to distinguish from common pneumonia. However, this type of pneumonia leads to rapid progression to respiratory failure. Here we report a 62-year-old healthy male plumber without chronic diseases who had back pain, chest pain, and a cough with blood-tinged sputum for several days. On admission, a chest X-ray showed right upper lobe pneumonia. Initially he was treated with empirical antibiotics. Massive hemoptysis and respiratory failure developed the day after admission. Computerized tomography revealed necrotizing change of the right upper lobe lung and consolidation of the posterior parts of both lungs. He underwent thoracoscopic right upper lobectomy because of the disease progression, and was discharged uneventfully. Based on the disease presentation of our patient, we consider his condition to be compatible with the diagnosis of Pseudomonas aeruginosa necrotizing pneumonia. Early surgical intervention combined with adequate antibiotics could have saved the patient’s life.