Fujita Yu, Hirano Satoshi, Yoneshim Yasuto, Izumi Shinyu, Takeda Yuichiro, Sugiyama Haruhito, Kobayashi Nobuyuki, Kudo Koichiro
Department of Respiratory Medicine, National Center for Global Health and Medicine.
Nihon Kokyuki Gakkai Zasshi. 2011 Feb;49(2):108-15.
A 72-year-old man was referred to our hospital with complaints of cough, facial rash, proximal muscle pain and weakness. Chest computed tomography (CT) revealed a nodule in the right S6, interstitial pneumonia in bilateral lower lobes and mediastinal lymph node swelling. A biopsy specimen of the nodule revealed non-small cell lung carcinoma. Gottron's sign was noted on his hands, and elevated skeletal muscle enzymes were recognized. Based on clinical and histopathological examinations, the patient was given a diagnosis of dermatomyositis. He was treated with chemotherapy (carboplatin/paclitaxel) for lung cancer and his dermatomyositis was treated with steroids (1 mg/kg of prednisolone) for prolonged muscle pain and cough. Although both therapies were successful, he died of respiratory failure due to acute exacerbation of interstitial pneumonia. In the present case, we found that decreasing tumor size might be related to the activity level of skin and muscle symptoms, not interstitial pneumonia. A combination of 3 diseases is thought to be very rare, and we discussed the intercorrelation among lung cancer, dermatomyositis and interstitial pneumonia with a review of the literature.
一名72岁男性因咳嗽、面部皮疹、近端肌肉疼痛和无力被转诊至我院。胸部计算机断层扫描（CT）显示右肺S6结节、双侧下叶间质性肺炎和纵隔淋巴结肿大。结节活检标本显示为非小细胞肺癌。患者双手可见Gottron征，且骨骼肌酶升高。基于临床和组织病理学检查，该患者被诊断为皮肌炎。他接受了针对肺癌的化疗（卡铂/紫杉醇），其皮肌炎则使用类固醇（1mg/kg泼尼松龙）治疗以缓解长期的肌肉疼痛和咳嗽。尽管两种治疗均取得成功，但他因间质性肺炎急性加重导致呼吸衰竭死亡。在本病例中，我们发现肿瘤大小的减小可能与皮肤和肌肉症状的活动程度相关，而非间质性肺炎。三种疾病并存被认为非常罕见，我们结合文献讨论了肺癌、皮肌炎和间质性肺炎之间的相互关系。
