Kusagaya Hideki, Yokomura Koshi, Oyama Yoshiyuki, Yasui Hideki, Matsui Takashi, Matsuda Hiroyuki, Nakano Yutaka, Haneda Yuji, Niwa Hiroshi, Suda Takafumi, Chida Kingo
Department of Respiratory Medicine, Respiratory Disease Center, Seirei Mikatahara Hospital.
Nihon Kokyuki Gakkai Zasshi. 2009 Jun;47(6):531-6.
A 25-year-old man was referred to our hospital because of cough and an abnormal shadow on chest X-ray film showing bilateral hilar lymphadenopathy accompanied by multiple nodules in both lung fields. A transbronchial lung biopsy demonstrated non-caseating epithelioid cell granulomas, and we diagnosed sarcoidosis. He was observed without medication for 18 months, however, his chest X-ray film findings gradually worsened, and bilateral pleural effusion appeared. The pleural effusion consisted of exudative fluid with prominent lymphocytes, and ADA level was elevated to 57.0U/l. Thoracoscopy demonstrated multiple whitish granulations on the parietal and visceral pleura. The pleural biopsy specimens exhibited non-caseating epithelioid cell granulomas, and there was no evidence of acid-fast bacilli. Based on these findings, pleural sarcoidosis was diagnosed. He was treated with 30 mg oral prednisolone daily, and both pleural effusion and nodules of lung fields on chest X-ray film subsided. Sarcoidosis with bilateral pleural effusions is rare, and we discuss this condition in relation to the pertinent literature.
一名25岁男性因咳嗽和胸部X光片异常阴影被转诊至我院，该阴影显示双侧肺门淋巴结肿大并伴有双肺野多发结节。经支气管肺活检显示非干酪样上皮样细胞肉芽肿，我们诊断为结节病。他未接受药物治疗观察了18个月，然而，他的胸部X光片表现逐渐恶化，出现了双侧胸腔积液。胸腔积液为渗出液，淋巴细胞显著增多，腺苷脱氨酶（ADA）水平升高至57.0U/l。胸腔镜检查显示壁层和脏层胸膜有多个白色颗粒。胸膜活检标本显示非干酪样上皮样细胞肉芽肿，未发现抗酸杆菌。基于这些发现，诊断为胸膜结节病。他接受了每日30mg口服泼尼松龙治疗，胸腔积液和胸部X光片上的肺野结节均消退。双侧胸腔积液的结节病罕见，我们结合相关文献对这种情况进行讨论。
