A 58-year-old man was admitted with a typical presentation of acute left heart failure. However, the patient showed a partial response to the anti-heart failure therapy. Following admission, a continuous fever was monitored, and a CT scan revealed that multiple opacities on bilateral lungs had progressed. Bronchoscopy was performed, and Coxiella burnetii was detected by Metagenomic next-generation sequencing (mNGS) in bronchoalveolar lavage (BALF), and transbronchial lung biopsy showed organizing pneumonia. Considering that the patient had a history of rabbit breeding and delivery, with some newborn rabbits dying before he became ill, organizing pneumonia secondary to Q fever pneumonia was diagnosed. Anti-Q fever treatment was initiated and the patient's temperature returned to normal. Glucocorticoid was administered after adequate treatment for Q fever. The patient's symptom of dyspnea relieved soon and opacities on CT scan were absorbed remarkably. The final diagnosis was organizing pneumonia secondary to Q fever pneumonia accompanied with left heart failure.
本文报道了1例58岁男性患者，以急性左心功能不全表现就诊，但抗心力衰竭治疗效果不理想。入院后监测到持续发热、影像学进展，支气管肺泡灌洗液检出贝纳特柯克斯体，肺组织病理提示机化性肺炎。患者饲养家兔，发病前曾给孕兔接生，部分幼兔生后死亡，综合考虑为Q热肺炎继发机化性肺炎。针对Q热肺炎抗感染治疗后患者体温正常，进一步加用糖皮质激素治疗，患者症状缓解且肺部阴影吸收。最终明确诊断为Q热肺炎继发机化性肺炎合并心功能不全。.