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Abstract: The patient complained of recurrent cough and sputum for 10 days with a cold, the effect of oral cold medicine was not good, and fever appeared 5 days later, and was treated with injectable cefoperazone sodium sulbactam sodium plus levofloxacin hydrochloride injection and other drugs on sedation, and the lung CT lesion was not absorbed on review. After X-ray examination, HRCT examination, combined with the patient’s performance, the diagnosis was cryptogenic mechanized pneumonia. He was admitted to the hospital and treated with prednisone acetate. The cough and sputum symptoms gradually subsided until they disappeared, and the lesions were absorbed on imaging.
Basic information】Female, 35 years old
Disease Type】Cryptogenic mechanized pneumonia
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】January 2022
Treatment plan】Medication (prednisone acetate tablets) + physical cooling
Treatment period】14 days of hospitalization and 1 month of outpatient follow-up
Effectiveness of treatment】Cough and sputum symptoms gradually relieved to disappeared, and the lesions were absorbed in the imaging examination
I. Initial consultation
The patient complained of recurrent cough and sputum for 10 days, and the effect of oral cold medicine was not good. 5 days later, he developed fever with temperature reaching 38.7℃ without chills, and was given cefoperazone sodium sulbactam sodium for injection plus levofloxacin hydrochloride injection for 5 days and moxifloxacin hydrochloride injection for 11 days. The patient did not have a sunward rash, shawl sign, mechanic’s hand, or Raynaud’s phenomenon. The examination showed a body temperature of 37.0℃, heart rate of 88 times/min, respiration of 20 times/min, blood pressure of 120/80mmHg, clear, coarse breath sounds in both lungs, Velcro rales could be heard, heart rhythm was uniform, no obvious murmur in each valve area, abdominal softness, no pressure pain and rebound pain, no abnormalities in the liver, gallbladder, pancreas and spleen, no edema in both lower limbs. He was admitted to the hospital for treatment because of the possibility of cryptogenic mechanized pneumonia.
II. Treatment history
The patient’s chest X-ray showed bilateral diffuse alveolar hyperdense shadows with peripheral distribution, and HRCT scan showed patchy air cavity solidity, ground glass shadows, small nodular shadows, and bronchial wall thickening and dilatation. Pulmonary function tests showed restrictive impairment without obstructive ventilatory dysfunction. Blood gas analysis showed resting and post-exercise hypoxemia. The diagnosis of cryptogenic mechanized pneumonia was confirmed by combining the patient’s examination findings, clinical symptoms and features of ineffective anti-infective treatment. As the patient was a primary non-serious case, treatment was given with oral prednisone acetate tablets with monthly dose reduction. Physical cooling methods were used to help the patient control his body temperature. After 14 days of treatment, the CT lesion was rechecked for absorption.
III. Treatment effect
After 48 hours of administration of hormone therapy, the patient’s cough and sputum symptoms were gradually relieved, and the body temperature decreased after physical hypothermia. During the course of 14 days of hospitalization, the patient’s symptoms continued to decrease until they disappeared. The patient’s lung CT was reexamined before discharge and showed some absorption of the lesion. Since cryptogenic mechanized pneumonia is a chronic disease, the patient can go home and take oral prednisone acetate tablets as prescribed by the doctor and return to the hospital for review after 1 month.
IV. Precautions
I was very pleased to see the patient’s symptoms decrease day by day, his mental state slowly improved, and he gradually met the discharge criteria. Patients with cryptogenic mechanized pneumonia may relapse during the process of hormone discontinuation, so the patients were instructed to visit the hospital for regular review. In the process of applying hormones, patients should pay close attention to the side effects of using hormones, such as elevated blood glucose and blood pressure, or secondary to other infections.
V. Personal insight
Cryptogenic mechanized pneumonia is a type of interstitial lung disease with a relatively good prognosis, but it needs to be noted clinically that it is easily confused with infectious lung disease and other causes of mechanized pneumonia. To clarify the diagnosis of cryptogenic mechanized pneumonia, other causes of mechanized pneumonia need to be considered, and the patient’s condition needs to be differentiated from connective tissue disease-associated interstitial pneumonia, fungal pneumonia, bacterial pneumonia, and viral pneumonia.