Chiba Sahoko, Jinta Torahiko, Chohnabayashi Naohiko, Fujie Toshihide, Sumi Yuki, Inase Naohiko
Department of Integrated Pulmonology, Tokyo Medical and Dental University, Tokyo, Japan.
BMJ Case Rep. 2012 Mar 20;2012:bcr0920114857. doi: 10.1136/bcr.09.2011.4857.
A 61-year-old female presented with a dry cough and fever 4 months after tangential radiation therapy (RT) following conserving surgery for breast cancer. Chest radiography and CT demonstrated consolidation with air bronchogram outside the irradiated area. Neutrophil granulocytes were abundant in bronchoalveolar lavage fluid (BALF) (39.6% of total cells), and transbronchial lung biopsy revealed organising pneumonia (OP) histologically. Antibiotic therapy had no effect, but corticosteroid therapy brought about clinical improvement. Her condition was diagnosed as bronchiolitis obliterans OP (BOOP) syndrome. Lymphocytic BALF has been identified as a characteristic of BOOP syndrome induced after RT for breast cancer. The BALF in this case, however, was neutrophilic. In our analysis of differential cell counts in the BALF of 24 patients with BOOP syndrome, the BALF was neutrophilic (>5%) in 16 (76%) cases, and the neutrophilia was severe in some of those patients.
一名61岁女性在乳腺癌保乳手术后接受切线放射治疗（RT）4个月后出现干咳和发热。胸部X线和CT显示照射区域外有实变并伴有空气支气管征。支气管肺泡灌洗（BALF）液中中性粒细胞丰富（占总细胞的39.6%），经支气管肺活检组织学显示为机化性肺炎（OP）。抗生素治疗无效，但皮质类固醇治疗使临床症状改善。她的病情被诊断为闭塞性细支气管炎伴机化性肺炎（BOOP）综合征。淋巴细胞性BALF已被确定为乳腺癌放疗后诱发的BOOP综合征的一个特征。然而，该病例的BALF为中性粒细胞性。在我们对24例BOOP综合征患者BALF细胞分类计数的分析中，16例（76%）患者的BALF为中性粒细胞性（>5%），其中一些患者中性粒细胞增多明显。
