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1、个案报道支原体肺炎GeneralDateName:賴xxAge:20歲Sex:男性Occupation:cementworkerAdmissiondate:90-8-28Dischargedate:90-9-1ChiefComplaintFeverandchillssensationforadayProductivecoughwithyellowishsputumLaboratorydateHE檢驗項目08/28單位====================================WBC21.710
2、^3/uLRBC4.7910^6/uLHGB15.8g/dlHCT44.5%MCV92.9fLMCH33.0pgMCHC35.5%Platelet19210^3/uLN-Seg83%Lymph3%Mono4%N-Band9%ImpressionInterstitiallungdisease,causedtobedeterminedR/oHypersensitivitypneumoniaR/oAtypicalpneumoniaR/oAutoimmunedisease？PlainofManagementCol
3、lectsputumforroutine,cultureandTBsurveyArrangepleuralechoforevaluationifpossibleEmpiricantibioticUnasynandErythromycinCheckbasicbiochemistryprofileArrangeHRCTforstudyHospitalcourse(一)90-8-28Hefeltdeathduetodifficultbreathingand(8pm)gotmoreandmore.SOBsensa
4、tionBreathingsound:bilateraldiffusewheezing.BronchodilatorinhalationSolu-cortef100mgIBst90-8-29Stilldyspneaandhighfeverupto39.2°CO2saturation:89-91%/nasalcannula3L/minABGdata:PH:7.410,HCO3:16.9mmol/lPCO2:27.3mmHg,BE:-6.0mmol/lPO2:49.0mmHg,SaO2:84.0%Bioche
5、mistryLab:GOT:30IU/I,BUN:7.6mg/dl,Na:137meq/lGPT:13IU/I,Cr:1.1mg/dl,K:3.9meq/lLDH:769U/l,Ca:8.1mg/dl,CRP:16.2mg/dlSolu-cortef200mgIBstHospitalcourse(二)90-8-30PersistenthighfeveranddyspneaF/UCXRrevealedinterstitialinfiltrationHRCTshowedinterstitialpatchcon
6、solidationwithair-bronchogramandincreasedinterstitialinfiltrationoverbilaterallungsO2saturation:90%withventuri-mask40%CheckthetitleofatypicalpathogenandimmunesuchasMycoplasmaAb,LegionellaAb,HIV,ANAandCD4/8ConsiderEndo-tubeifrespiratoryfailure90-8-31Fevers
7、ubsideandimprovedyspneaO2saturation:94%withventuri-mask40%F/UCBC/DC:WBC:12.210^3/uL,Platelet:21910^3/uLRBC:4.5210^6/uL,N-Seg:67%Hb:14.3g/dl,Lymph:7%HCT:42.6%,Mono:5%MCV:94.1fL,N-Band:14%Hospitalcourse(三)90-9-1Clinicalsymptomsgraduallyimprovedandaskedtobed
8、ischargefromhospital.AADfinally90-9-3HIVAb1:32X(-)ANANegMycoplasmaAb>1:1280X(+)LegionellaAb1:100X(-)IgE5.40IU/mLRadiographicappearancesofMycoplasmapneumonia(一)ManypatientswithM.pneumoniaepneumoniahavenonspecticclini
