Blanc A-L, Delhaes L, Copin M-C, Stach B, Faivre J-B, Wallaert B
Service de pneumologie et immunoallergologie, centre de compétence des maladies pulmonaires rares, CHRU hôpital Calmette, boulevard du Pr-J.-Leclercq, 59037 Lille cedex, France.
Rev Mal Respir. 2011 Sep;28(7):913-8. doi: 10.1016/j.rmr.2011.01.013. Epub 2011 Jun 23.
Identifying the role of fungi present in the domestic environment in the development of interstitial pneumonia can be a difficult clinical problem. We report a case of interstitial lung disease case occurring in a 53-year-old patient. He presented with profound hypoxemia (PaO(2) 54mmHg). Chest CT showed diffuse ground glass opacities. Initial blood tests for allergy and autoimmune disease were negative. Faced with a worsening of his clinical status after returning home he was hospitalized several times. At fibreoptic bronchoscopy, multiple white deposits were observed. Bronchoalveolar lavage with differential cell count was performed, revealing a 23% lymphocytosis. Serology for specific household molds showed moderate reaction to various molds found in homes, especially Stachybotrys chartarum. Pulmonary function tests revealed a moderate restrictive pattern with impaired diffusion of carbon monoxide and a bronchiolocentric interstitial pneumonia was found at lung biopsy. After a permanent move to a new residence, clinical parameters, radiological, biological and functional normalized. The final diagnosis was interstitial lung disease related to mycotoxins of S. Chartarum. The diagnosis of hypersensitivity pneumonitis to domestic mold or interstitial lung disease secondary to mycotoxins should be considered in patients presenting with interstitial pneumonia and requires specific investigations to ensure that an environmental cause with an allergic or toxic role is not missed.
确定家庭环境中存在的真菌在间质性肺炎发病中的作用可能是一个棘手的临床问题。我们报告一例发生在一名53岁患者身上的间质性肺病病例。他表现为严重低氧血症（动脉血氧分压54mmHg）。胸部CT显示弥漫性磨玻璃影。最初的过敏和自身免疫性疾病血液检查均为阴性。回家后其临床状况恶化，他多次住院。在纤维支气管镜检查时，观察到多处白色沉积物。进行了支气管肺泡灌洗及细胞分类计数，显示淋巴细胞增多23%。针对特定家庭霉菌的血清学检查显示对家庭中发现的各种霉菌有中度反应，尤其是黑曲霉。肺功能测试显示为中度限制性模式，一氧化碳弥散受损，肺活检发现以细支气管为中心的间质性肺炎。永久搬到新住所后，临床参数、影像学、生物学和功能指标均恢复正常。最终诊断为与黑曲霉霉菌毒素相关的间质性肺病。对于出现间质性肺炎的患者，应考虑诊断为对家庭霉菌的过敏性肺炎或霉菌毒素继发的间质性肺病，并且需要进行特定检查以确保不遗漏具有过敏或毒性作用的环境病因。
