Arai M, Kawada H, Kaburagi T, Sakai N, Kudou Y, Kawakami M, Konno K, Takizawa T
Chest Institute Department of Medicine, Tokyo Women's Medical College, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1991 Nov;29(11):1457-63.
A 40-year-old man who lived in a wooden house built 30 years ago presented with complaints of fever, dry cough and dyspnea. Chest X-ray findings showed interstitial shadows throughout bilateral lung fields. After admission, high-dose administration of 3000 mg of methylprednisolone was performed because of deterioration of chest X-ray shadows and symptoms. In a week, clinical data and symptoms improved. Findings of BAL fluid on admission revealed a relative increase of lymphocytes, neutrophils and mast cells, and pathological findings of transbronchial lung biopsy revealed non-caseous granulation and alveolitis. Precipitating antibodies and indirect fluorescent antibodies against Trichosporon cutaneum and Cryptococcus neoformans had positive reactions and T. cutaneum was isolated and identified from the patient's house. A diagnosis of summer-type hypersensitivity pneumonitis was made according to the criteria advocated by Ando et al. This seemed to be a rare case of summer-type hypersensitivity pneumonitis prolonged after isolation from his normal living environment, successfully treated by high-dose administration of steroid.
一名居住在30年前建造的木屋中的40岁男子，出现发热、干咳和呼吸困难的症状。胸部X线检查结果显示双侧肺野布满间质阴影。入院后，由于胸部X线阴影和症状恶化，给予3000毫克甲泼尼龙大剂量治疗。一周后，临床数据和症状有所改善。入院时支气管肺泡灌洗液检查结果显示淋巴细胞、中性粒细胞和肥大细胞相对增多，经支气管肺活检的病理检查结果显示为非干酪样肉芽肿和肺泡炎。针对皮状丝孢酵母和新型隐球菌的沉淀抗体及间接荧光抗体呈阳性反应，且从患者家中分离并鉴定出了皮状丝孢酵母。根据安藤等人倡导的标准，诊断为夏季型过敏性肺炎。这似乎是一例罕见的夏季型过敏性肺炎病例，在脱离正常生活环境后病情迁延，通过大剂量使用类固醇成功治愈。
