Zaizen T, Soda K, Sugimato M, Matsumoto M, Kohrogi H, Yamasaki H, Sakata T, Saita N, Ando M, Araki S
First Department of Internal Medicine, Kumamoto University Medical School, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1992 Aug;30(8):1589-93.
A 34-year-old male patient was admitted to our hospital because of progressive exertional dyspnea and weight loss (8 kg in one year). Twelve years previously, he had had an episode of uveitis accompanied with bilateral hilar lymphadenopathy. Scalene node biopsy at that time revealed non-caseating epithelioid granulomas. Four years later, a follow-up chest radiograph showed bilateral fine nodular lesions. The bilateral parenchymal lesions gradually increased in density, and eventually, formed a confluent air-space consolidation containing multi-ocular cavities. On physical examination, the patient was emaciated (Ht 165 cm, Wt 40 kg). Nodular cutaneous lesions were present on his face and elbows. Hypoxemia with hypercapnea (PaO2 56 Torr, PaCO2 51 Torr) was noted. Repeated sputum cultures yielded negative results for acid-fast bacilli, fungi, and other pathological organisms. A transbronchial lung biopsy specimen obtained from near the cavitary lesion revealed non-caseating granulomas compatible with sarcoidosis. Skin lesion biopsy showed similar findings. The cavitation, was therefore considered to be due to ischemic necrosis of confluent sarcoid granulomas. Prednisolone (40 mg daily) was given with a prompt improvement of symptoms including dyspnea, as well as the radiographic abnormalities. We conclude that uncomplicated pulmonary sarcoidosis may rarely develop into an aggressive parenchymal disease with cavitation. It is of importance to differentiate such cases from infectious diseases (tuberculosis, mycosis etc.) because of the need for corticosteroid treatment.
一名34岁男性患者因进行性劳力性呼吸困难和体重减轻（一年内减轻8公斤）入院。12年前，他曾患葡萄膜炎并伴有双侧肺门淋巴结肿大。当时的斜角肌淋巴结活检显示为非干酪样上皮样肉芽肿。4年后，胸部X线片随访显示双侧细小结节状病变。双侧实质病变密度逐渐增加，最终形成融合的气腔实变，内有多房性空洞。体格检查时，患者消瘦（身高165cm，体重40kg）。面部和肘部有结节性皮肤病变。发现低氧血症伴高碳酸血症（动脉血氧分压56托，动脉血二氧化碳分压51托）。多次痰培养抗酸杆菌、真菌及其他病原微生物均为阴性。从空洞病变附近获取的经支气管肺活检标本显示为与结节病相符的非干酪样肉芽肿。皮肤病变活检也显示类似结果。因此，空洞被认为是由于融合的结节病肉芽肿缺血坏死所致。给予泼尼松龙（每日40mg）后，包括呼吸困难在内的症状以及影像学异常迅速改善。我们得出结论，无并发症的肺结节病很少发展为具有空洞的侵袭性实质疾病。由于需要使用皮质类固醇治疗，将此类病例与传染病（结核病、真菌病等）区分开来很重要。
