Fujisawa N, Katoh O, Yamaguchi T, Kawashima M, Nakata H, Sueoka N, Aoki Y, Kuroki S, Nakahara Y, Yamada H
Department of Internal Medicine, Saga Medical School, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1992 Dec;30(12):2146-50.
A 29-year-old man presented with acute onset of high fever, chest pain and dyspnea. Chest X-ray film showed diffuse interstitial shadows, a cavitary lesion in the left upper lung field and cardiomegaly, but no lymphadenopathy. Abdominal CT scan showed hepatosplenomegaly and multiple small low density areas in the liver and spleen. Electrocardiogram demonstrated multifocal ventricular premature beats and ventricular tachycardia. Cardiac catheterization revealed left ventricular aneurysms. Sarcoidosis was confirmed by lung and liver biopsy. Drug therapy of prednisolone and mexiletine resulted in clinical improvement of symptoms, signs and chest X-ray film, but platelet count decreased gradually. It is suggested that an immune mechanism of sarcoidosis may have been the cause of this thrombocytopenia.
一名29岁男性出现高热、胸痛和呼吸困难急性发作。胸部X线片显示弥漫性间质阴影、左上肺野有空洞性病变及心脏扩大，但无淋巴结肿大。腹部CT扫描显示肝脾肿大以及肝脏和脾脏内多个小低密度区。心电图显示多灶性室性早搏和室性心动过速。心脏导管检查发现左心室室壁瘤。经肺和肝活检确诊为结节病。泼尼松龙和美西律药物治疗使症状、体征及胸部X线片有临床改善，但血小板计数逐渐下降。提示结节病的免疫机制可能是该血小板减少症的病因。
