Cough cough sputum for 6 years, the group eat hormones to eat tuberculosis!

!---- the first stage of the medical history of the introduction of Peng XX, 21 years old, recent college graduates, due to "seizure cough, coughing sputum, wheezing for 6 years, aggravated with fever 3 months" in December 2018 admitted to my department6 years ago, there was no obvious trigger for seizures of inter-seizure cough, coughing and sputumis a cough with no obvious circadian patternwheezing attacks at night and relieves themselvesin the local hospital lung function test tips: ventilation function is generally normal, bronchial diastocytosis test positivediagnoses "bronchial asthma" and is inhaled intermittently with "salbutamol" and oral "glucocorticoids", which can be alleviated, but repeated from time to time3 months ago after the cold again appeared coughing, coughing yellow sputum, accompanied by fever, local hospital visits, consider "bronchosal expansion", "bronchial asthma acute attack", "lung fungal disease", anti-infection, anti-fungus, sputum and other treatment, patients still have repeated cough, shortness of breath, for further treatment of my departmentphysical examination: 20 breaths/min, heart rate 82 times/min, SpO295%a clear mind, smooth breathing, the body's shallow lymph nodes did not touch the swellingdouble lung breathing sound thick, double under the lungs can smell and the wet sound of the inhaled phase, the right lower lung can smell and the dry sound of the exhalation phaseheart rate 82 times/min, qi, unheard of pathological and physiological murmursdid not show positive signs in the abdomendouble lower limbs without puffinesspast history: nothing specialAuxiliary examination inexternal hospital: blood routine: white blood cell 12.1 x 109/L, number of neutrophils 4.3 x 109/L, eeophilic granulocyte calcitonary (PCT) 0.42 ng/mL, blood sink 19 mm/h; 1 IU/mL (August 2018); Total IgE 3121 IU/mL (November 2018) exhaled nitrogen monoxide (FENO) 68bbp; outer hospital chest and sinus CT: double lung multiple bronchial dilation and infectionthe upper lobe of the right lung, the back section of the lower lobe and the upper leaf tongue section of the left lung, there are more than a small flaky real change; pulmonary ventilation function: mild obstructive ventilation dysfunction, diastosis test positive Figure 1: The first chest CT Guangzhou Medical University affiliated with the first hospital respiratory medicine department Director Of the doctor check room analysis: 1, young men, chronic disease course acute exacerbation; physical examination: double lung breathing sound thick, double lower lung can smell and absorb the wet sound of the inhaled phase; chest CT prompts bronchial dilation and infection; blood total IgE is greater than 1000 IU/mL blood routine suggests significant increase in acidosis cells current diagnosis: the possibility of variable bronchial pulmonary psoriasis is high 2, combined with the characteristics of the case, currently considerthe variable bronchial pulmonary psoriasis is likely, but need to exclude the possibility of other special pathogen infection as soon as possible to improve the skin sting test of smoking mold, our hospital total IgE, fungal G test, GM test, tobacco-curic mold IgG antibody, blood TB-SPOT, tracheoscopy to leave the lung foam irrigation lotion pathogen improve the relevant examination of fungi, tuberculosis and other pathogens: blood routine: white blood cell 11.1 x 109/L, number of neutrophils 4.3 x 109/L; eosinophils 0.78 x 109/L; peripheral blood total IgE: 4345 IU/mL, smoking mold IgE (m3): 7.7.54 ku/L; Blood T-SPOT negative (A-hole 6, B-hole 7); flucinomycin-specific IgG antibodies: 78 AU/mL; Skin sting test: rheutium (diameter 8 mm s) bud mold genus (diameter 2 mm s), multiple sputum smears not found anti-acid bacteria; tracheoscopy, airway disease not seen deep sputum TB-DNA negative, alveolar irrigation washes X-pert negative, alveolar irrigation washes GM negative; Table 1: Diagnostic Criteria for Variant Bronchopulmonary Pneumocosis Table 2: Diagnostic variantbronpulmonary pneumomelym phase table 3: Treatment regimen of different stages of bronchial pulmonary psoriasis to Iqucana mixed suspension 200 mg bid; methyl-spraying nylon 24 mg qd oral regular outpatient follow-up, peripheral blood total IgE showed a downward trend, review CT, lesions in absorption, symptoms stable assess the condition after January, the total IgE changes: Figure 2: Chest CT instructions reviewed after January after medication continue to be used regularly the second stage of the cloud light wind after the rain clouds near graduation, excellent Xiao Peng has received several jobs Offer, but in April 2019, the patient has no obvious cause of coughing, sputum, gas symptoms again aggravated, fever, re-admission Figure 3: In April 2019, the chest CT Guangzhou Medical University affiliated with the first hospital respiratory medicine director Ye Feng after the room show: 1, young men, chronic disease course acute exacerbation, seizure cough, coughing sputum, wheezing for 6 years, aggravated with fever in March was diagnosed with mild pulmonary psycosis in our hospital 2, body check: body temperature 38 degrees C, double lung breathing sound thick, can smell and the right lower lung inhaler of the wet sound; current diagnosis: right lung real change, special pathogen infection? Malignant bronchial pulmonary psycosis? Combined with the characteristics of the case, the current symptoms increase, the increase of imaging lesions, need to consider the following factors: the exacerbation of varicose bronchopulmonary psycosis; as soon as possible to review the total blood IgE, fungal G test, GM test, niacin mold IgG antibody, blood TB-SPOT, tracheoscopy to leave alveoli irrigation lotion blood routine: white blood cells 10.1 x 109/L; neutrophils 4.5 x 109/L; eosinophils 0.4 x 109/L; blood PCT: 0.09 ng/mL; C reaction Protein: 7.17 mg/dL; Total Blood IgE: 850 IU/mL; m3:10.6 KU/mL; Blood T-SPOT negative (A-spot 80, B-hole 70) perfect tracheostoscopy: Figure 4: In April 2019, the tracheoscopy condition cavity congestion is obvious, the formation of the cavity is found in the upper right upper leaf section, necrosis can be seen in the cavity, but can not be absorbed, the touch of blood seepage, to be brushed and partial irrigation, biopsy X-pert positive for alveoli irrigation lotion; TB-DNA positive for alveoscosis; right upper lung brush smear smear: anti-acid bacteria: positive; alveoscoscopy culture (40 days after culture): tuberculosis mycobacteria Figure 5: Biopsy lung tissue in the upper right lung cavity after continuous multiple slices, visible epithelial cell necrosis, tissue changes in line with pulmonary granulomainflammation inflammation, combined with special staining, tend to lung anti-acid disease no lung tissue was invaded by qurindo special staining results: GMS (-), PAS (-), acid-acid (-), Gram (-), anti-acid fluorescence (-), fungal fluorescence (-), iron staining (-) our analysis: Why does the variable bronchial pulmonary palate combine tuberculosis? The host immune function of patients with variable bronchial pulmonary colitinol is complex and occurs in the case of immune function the use of glucocorticoids is intended to reduce the high reactivity of the airways, but the application of glucocorticoids can lead to impaired immune function, and the patient's immune state is likely to change, followed by the possibility of special pathogen infections Table 4: Immunodamage Type and Common Infection Pathogen Final Diagnosis: 1, Followed Hair Tuberculosis (right lung, alveoscosic irrigation liquid Xpert positive, initial treatment); : Referral to a specialist tuberculosis treatment hospital in Guangzhou 1, gradually reduce the amount, and with the discontinuation of glucocorticoids after February; 2, isoniazid 0.3 g qd; liofamp 450 mg qd; pyridine 500 mg tid; acetaminophen 750 mg qd; discontinuation of iquala the patient's fever, cough, cough sputum, shortness of breath symptoms relief but not finished.. The third stage of the cloud after the rain break of the wind surge swarmed my hospital outpatient consultation, again appeared cough, coughing sputum, shortness of breath symptoms physical examination: double lung breathing sound thick, can smell and the right lower lung exhalation phase of the dry sound Figure 6: The chest CT in July 2019 in the chest UPPER right lung again a large change of reality changes in total blood IgE: July 11, 2019, re-add meldonium nylon 20 mg, shortness symptoms have improved, but still complain of coughing, continue to use anti-pyroride drug process, August 1 to discontinue the process of using left oxyfluorasin 0.5 g qd, re-use of iquecon ailant 200 mg bid the analysis of the director of respiratory medicine at the First Hospital affiliated with Guangzhou Medical University: patients should change bronchial pulmonary psycosis combined tuberculosis, in the course of treatment, both need to be balanced, can not afford to lose otherwise the other disease will relapse and worsen to master the balance is the key to the success of treatment after continuing to take medication, we followed up with patients: October 2019 external chest CT: ooxyfluoracin 0.5g qd; isoniazid 0.3g qd; pyrethroid 500 mg tid; methylnylon 12 mgd; Iqucan200 mg Bid; December 2019 my hospital chest CT: left oxyfluorosacin 0.5 g qd; isoniazid 0.3 g qd; methyl nylon 12 mg qd; Iqucona 200 mg bid; June 2020 my hospital chest CT: basic absorption of lesions currently methyl-spraying nylon 4 mg; Iqucon 200 mg bid the change of total blood IgE, Director Ye Feng comment 1, "sputum" is the characteristic clinical manifestation of variable bronchopulmonary pulmonary mycosis, in the clinical diagnosis and treatment process, if we can reasonably and correctly collect information, help us to establish the correct diagnosis and treatment ideas 2, patients with variable bronchial pulmonary psycosis, the invivia of the body is complex there may be immune function transformation during the course of treatment, which deserves our attention 3, variable bronchial pulmonary rhymy disease in the long-term treatment process of the increase of the disease in addition to considering the different stages of reflexopulmonary pulmonary psycosis, still need to be alert to the combination of the infection of special pathogens 4, when the variant bronchial pulmonary psycosis combined tuberculosis, its treatment needs to do as far as possible to balance each other, can not afford to lose, need to find the best balance point Li Shaoqiang Ye Feng Source: Nanshan Breathing !-- Content Display Ends -- !-- Determine whether to log on to end.