Fujiwara K, Sato T, Yonei T, Genba K, Nogami N, Yamadori I
Department of Respiratory Medicine, Laboratory Medicine, Okayama National Hospital, 2-13-1 Minamigata, Okayama, 700-8566, Japan.
Nihon Kokyuki Gakkai Zasshi. 2000 Dec;38(12):908-13.
A 73-year-old woman was admitted to our hospital with a low-grade fever, dry cough and dyspnea on exertion as the chief complaints. She had been a professional shiitake mushroom grower for 50 years. Three years before visiting our hospital, she had been suspected of having hypersensitivity pneumonitis as a result of chest X-ray examination, bronchoalveolar lavage and transbronchial lung biopsy performed at another clinic. No antigens were identified at that time, but prednisolone was administered. On admission to our hospital, chest radiography and chest computed tomography revealed an interstitial shadow with subpleural honey-combing in both lower lung fields. After steroid pulse therapy, dyspnea on exertion and hypoxia improved moderately. Because of recurrence of the dyspnea, however, she was admitted on four separate occasions. On the second admission, an increase in lymphocytes was found by bronchoalveolar lavage, and septal lymphocytic infiltration accompanying fibrosis was demonstrated by transbronchial lung biopsy. On the fourth admission, a detailed immunological examination and an environmental survey were performed. The environmental provocation test yielded clinical symptoms similar to those experienced at the mushroom farm. Furthermore, tests of precipitation and lymphocyte proliferation in response to shiitake mushroom extracts were positive. Finally a diagnosis of chronic hypersensitivity pneumonitis induced by shiitake mushrooms was confirmed.
一名73岁女性因低热、干咳和劳力性呼吸困难为主诉入院。她从事香菇种植专业工作50年。在就诊我院三年前，她在另一诊所进行胸部X线检查、支气管肺泡灌洗和经支气管肺活检后，被怀疑患有过敏性肺炎。当时未鉴定出抗原，但给予了泼尼松龙治疗。入院时，胸部X线和胸部计算机断层扫描显示双下肺野有间质阴影伴胸膜下蜂窝状改变。经类固醇冲击治疗后，劳力性呼吸困难和低氧血症有中度改善。然而，由于呼吸困难复发，她曾四次入院。第二次入院时，支气管肺泡灌洗发现淋巴细胞增多，经支气管肺活检显示伴有纤维化的间隔淋巴细胞浸润。第四次入院时，进行了详细的免疫学检查和环境调查。环境激发试验产生了与香菇种植场经历相似的临床症状。此外，针对香菇提取物的沉淀试验和淋巴细胞增殖试验呈阳性。最终确诊为由香菇引起的慢性过敏性肺炎。
