探讨1例肺恶性肿瘤合并鹦鹉热衣原体感染导致重症肺炎患者的临床特征与诊治历程。

回顾性分析2023年12月3日西部战区总医院呼吸与危重症医学科收治的1例肺恶性肿瘤合并鹦鹉热衣原体感染所致重症肺炎患者的临床资料，并复习相关文献，总结鹦鹉热衣原体重症肺炎的临床特点及诊治策略。

患者女性，60岁，以高热、咳嗽、咳痰就诊，入院后给予无创呼吸机辅助通气及广谱抗生素美罗培南抗感染治疗，患者病情迅速进展，在实施气管插管有创机械通气后患者血氧饱和度仍难以维持，最终在体外膜肺氧合支持下行支气管镜检查及肺泡灌洗术，灌洗液行宏基因组学第二代测序(mNGS)检测明确致病菌为鹦鹉热衣原体，进而针对病原体先后加用多西环素、阿奇霉素、左氧氟沙星治疗，患者病情得以好转。最终，患者于本院胸外科接受胸腔镜下肺癌根治术，术后标本行基因检测提示EGFR 19外显子缺失突变，给予埃克替尼术后辅助治疗，病情完全缓解。

mNGS技术可有效提高鹦鹉热衣原体检出率，避免病情进一步恶化；对于鹦鹉热衣原体重症肺炎患者，早期呼吸支持及针对病原体的精准抗感染治疗有助于改善患者预后。

To investigate the clinical characteristics, diagnosis, and treatment course of a patient with lung malignancy complicated by severe pneumonia caused by Chlamydia psittaci infection.

The clinical data of a patient with lung malignancy complicated by Chlamydia psittaci induced severe pneumonia, admitted to the Department of Respiratory and Critical Care Medicine of the General Hospital of Western Theater Command on December 3, 2023, were retrospectively analyzed. Relevant literature was also reviewed to summarize the clinical features and management strategies for severe Chlamydia psittaci pneumonia.

A 60-year-old female patient presented with high fever, cough, and sputum production. After admission, she received non-invasive ventilation and broad-spectrum antibiotic therapy with meropenem. However, her condition deteriorated rapidly, and her oxygen saturation remained difficult to maintain even after endotracheal intubation and invasive mechanical ventilation. Subsequently, bronchoscopy and bronchoalveolar lavage (BAL) were performed under extracorporeal membrane oxygenation (ECMO) support. Metagenomic next-generation sequencing (mNGS) of the BAL fluid identified Chlamydia psittaci as the causative pathogen. Targeted antimicrobial therapy with doxycycline, azithromycin, and levofloxacin was sequentially administered, leading to clinical improvement. Ultimately, the patient underwent thoracoscopic radical resection for lung cancer. Postoperative genetic testing of the specimen revealed a deletion variation on exon 19 of EGFR. Adjuvant therapy with icotinib was initiated, resulting in complete remission.

mNGS technology can effectively improve the detection rate of Chlamydia psittaci and prevent further clinical deterioration. For patients with severe Chlamydia psittaci pneumonia, early respiratory support combined with precise targeted antimicrobial therapy is crucial for improving patient prognosis.