Hashizume T, Numata H, Matsushita K
Department of Internal Medicine, Department of Pathology, Yokohama Sakae Kyousai Hospital, 132 Katsura-cho, Sakae-ku, Yokohama, Japan.
Nihon Kokyuki Gakkai Zasshi. 2001 Jun;39(6):442-5.
A 47-year-old automobile painter developed dry cough, chills and dyspnea after four months of painting work. The spray contained isocyanates (HDI). A chest radiograph showed bilateral ground-glass shadows. The serum KL-6 level was very high: 11,100 U/ml. Marked lymphocytosis and a striking decrease in the CD4/CD8 ratio were observed in the bronchoalveolar lavage fluid. Transbronchial lung biopsy specimens showed alveolitis and bronchiolitis. Cessation of exposure to isocyanates improved the symptoms and laboratory data. We suspected that the patient was suffering from hypersensitivity pneumonitis induced by isocyanates. Specific IgG antibodies for TDI, MDI, and HDI were not demonstrated by enzyme-linked immunosorbent assay. Because abnormal shadows in the chest radiograph did not improve quickly after admission, we administered glucocorticoids which improved the symptoms, the chest radiograph findings, and the serum KL-6 level.
一名47岁的汽车喷漆工在从事喷漆工作四个月后出现干咳、寒战和呼吸困难。喷漆中含有异氰酸酯（HDI）。胸部X线片显示双侧磨玻璃影。血清KL-6水平非常高：11,100 U/ml。在支气管肺泡灌洗液中观察到明显的淋巴细胞增多以及CD4/CD8比值显著下降。经支气管肺活检标本显示肺泡炎和细支气管炎。停止接触异氰酸酯后症状和实验室数据有所改善。我们怀疑该患者患有由异氰酸酯引起的过敏性肺炎。酶联免疫吸附测定未检测到针对甲苯二异氰酸酯（TDI）、二苯基甲烷二异氰酸酯（MDI）和HDI的特异性IgG抗体。由于入院后胸部X线片上的异常阴影没有迅速改善，我们给予了糖皮质激素，症状、胸部X线片表现和血清KL-6水平均有所改善。
