Ishikawa Rie, Kamiya Hiroyuki, Ikushima Souichiro, Oristu Masaru, Takemura Tamiko
Department of Respiratory Medicine, Japanese Red Cross Medical Center.
Nihon Kokyuki Gakkai Zasshi. 2010 Feb;48(2):134-9.
The patient was a 48-year-old woman and current smoker. In May 2007, she moved to a new residence. In the middle of the following month, she developed acute respiratory distress and a fever (38 degrees C) after running her air conditioner continuously throughout the night. The chest X-ray film showed diffuse infiltrative shadows in the middle and lower lung fields. After hospital admission, her oxygenation improved without treatment and the infiltrates improved over the clinical course. As a consequence, we suspected hypersensitivity pneumonitis. The bronchoalveolar lavage showed predominant lymphocytes of 72.6%, with a low CD 4/8 ratio of 0.2. Transbronchial lung biopsy findings corresponded to acute hypersensitivity pneumonitis. The results of the environmental challenge test were positive only when her air conditioner was on, resulting, in a diagnosis of air-conditioner lung. Several microorganisms were detected in an environmental sample, but 20 kinds of serum precipitating antibodies were negative on a thorough screening, so no responsible antigen could be identified. The patient's symptoms did not recur after her air conditioner was replaced.
患者为一名48岁的女性，目前仍在吸烟。2007年5月，她搬到了一处新住所。在接下来那个月的中旬，她在整晚持续开着空调后出现了急性呼吸窘迫和发热（38摄氏度）。胸部X光片显示中下肺野有弥漫性浸润阴影。入院后，未经治疗她的氧合情况有所改善，并且浸润影在病程中也有所好转。因此，我们怀疑是过敏性肺炎。支气管肺泡灌洗显示淋巴细胞占比达72.6%为主，CD4/8比例较低，为0.2。经支气管肺活检结果符合急性过敏性肺炎。环境激发试验结果仅在她的空调开启时呈阳性，最终诊断为空调肺。在环境样本中检测到了几种微生物，但经过全面筛查20种血清沉淀抗体均为阴性，因此无法确定相关抗原。更换空调后患者的症状未再复发。
