Nagata Nobuhiko, Harada Susumu, Wakamatsu Kentaro, Shigyo Mutsumi, Kajiki Akira, Kitahara Yoshinari
Department of Internal Medicine and Division of Clinical Research, National Omuta Hospital.
Nihon Kokyuki Gakkai Zasshi. 2004 Aug;42(8):767-71.
A 62 year-old woman presented with diffuse, centriacinar nodular densities on chest radiography and CT, and an increase of peripheral blood eosinophils, four years after diagnosis of bronchial asthma. Diffuse panbronchiolitis was diagnosed, and was treated with erythromycin for a long period. One year later, she noticed exertional dyspnea, and her chest radiograph showed increased nodular densities. Lung biopsy under video-assisted thoracoscopy was performed, and revealed chronic bronchiolitis with eosinophilic infiltration, and focal, peribronchiolar eosinophilic infiltration in the alveolar septa and alveoli. She was treated with prednisolone, and her symptoms and nodular densities on chest radiography and CT were improved. We consider that the clinico-pathological findings of this case are consistent with those of chronic eosinophilic bronchiolitis, which has recently been reported in Japan. This case is different from previously reported ones in that eosinophilic bronchiolitis appeared in the course of bronchial asthma, suggesting the possibility that eosinophilic bronchiolitis may be accompanied with bronchial asthma or eosinophilic pneumonia.
一名62岁女性,在诊断为支气管哮喘四年后,胸部X线和CT检查显示弥漫性、中心性腺泡结节状密度影,外周血嗜酸性粒细胞增多。诊断为弥漫性泛细支气管炎,并长期使用红霉素治疗。一年后,她出现劳力性呼吸困难,胸部X线显示结节状密度影增加。在电视辅助胸腔镜下进行了肺活检,结果显示为慢性细支气管炎伴嗜酸性粒细胞浸润,以及在肺泡间隔和肺泡中局灶性、支气管周围嗜酸性粒细胞浸润。她接受了泼尼松龙治疗,症状以及胸部X线和CT上的结节状密度影均有所改善。我们认为该病例的临床病理表现与日本最近报道的慢性嗜酸性粒细胞性细支气管炎一致。该病例与先前报道的病例不同之处在于嗜酸性粒细胞性细支气管炎出现在支气管哮喘病程中,提示嗜酸性粒细胞性细支气管炎可能与支气管哮喘或嗜酸性粒细胞性肺炎并存。