A Missed Diagnosis Case Report of Nephrotic Syndrome Complicated with Pneumocystis Pneumonia and Literature Review

HU Rui-lan; ZHU Xiong-long; YU Yong-wu

doi:10.3969/j.issn.1002-3429.2017.04.015

Abstract：Objective To investigate clinical features and key points of diagnosis and treatment of pneumocystis pneumonia (PCP) in order to reduce misdiagnosis and missed diagnosis rates.Methods Clinical data of 1 patient with nephrotic syndrome (NS) complicated with PCP was retrospectively analyzed, and related literature was reviewed.Results A 74 years-old female was admitted for bilateral lower extremity edema, fever and shortness of breath for three times.The patient was diagnosed as having NS by results of renal biopsy of the first time after admission, and 36 mg 1/d Methylprednisolone Tablets was given orally, and the symptoms were relieved.The patient had again bilateral lower extremity edema, systemic congestive skin rash and itching 2 months later, and was diagnosed as having drug allergy in emergency department of other hospital, and symptomatic treatment was followed.The patient was transferred to nephropathy department of our hospital on the next day, and symptomatic treatment for NS was still given, and the condition was alleviated.The patient was admitted to our hospital for the third time because of the above symptoms two months later.Chest CT examination showed that both lungs had multiple patching-like glass opacity shadow, multiple small nodules and strip-like dense shadow, and PCP was confirmed after finding pneumocystis by bronchoalveolar lavage fluid and cultivation.The conditions had been relieved after positively anti infection treatment, however pulmonary infection of acinetobacter baumannii occurred during the course of disease due to advanced age and complicated condition, and the patient died of respiratory failure although active treatment.Conclusion Clinicians should pay more attention to concurrent PCP for NS patients with long-term medication of corticosteroids, who have fever, shortness of breath and signs of pulmonary infection, and pneumocystis detection by bronchoalveolar lavage fluid and cultivation can be used as a diagnostic basis.