Hürter T, Schlegel J, Lorenz J, Rumpelt H J
Medizinische Klinik I, Klinikum der Technischen Hochschule Aachen.
Dtsch Med Wochenschr. 1990 Aug 3;115(31-32):1188-92. doi: 10.1055/s-2008-1065140.
Pneumonia was diagnosed radiologically in three patients (43, 54 and 58 years old, respectively), presenting with temperatures between 39 degrees and 40 degrees C, cough and weight loss. These signs persisted for 6, 7 and 13 weeks, respectively, but the pathogens could not be cultivated. Lung function analysis showed partial respiratory insufficiency with extensive restrictive impairment of ventilation. Samples of lung tissue were obtained in all three cases and histology revealed fibrosing alveolitis. In two patients serology yielded antibody titres of 1:512 and in one patient of 1:128, against Legionella pneumophila. Treatment with 1 g erythromycin three times daily was unsuccessful. Therefore, the patients were given prednisone at an initial dosage of 50-100 mg which was subsequently reduced. Lung function normalised during this treatment course, radiological findings and antibody titres receded. Hence, treatment with corticosteroids should be attempted if there is an urgent suspicion of fibrosing alveolitis caused by Legionella pneumophila, after having excluded a florid infectious pneumonia and after failure of erythromycin treatment.
三名患者（分别为43岁、54岁和58岁）经影像学诊断为肺炎，表现为体温在39摄氏度至40摄氏度之间、咳嗽和体重减轻。这些症状分别持续了6周、7周和13周，但病原体未能培养出来。肺功能分析显示存在部分呼吸功能不全，伴有广泛的通气限制性损害。所有三例均获取了肺组织样本，组织学检查显示为纤维化肺泡炎。两名患者的血清学检测针对嗜肺军团菌的抗体滴度为1:512，一名患者为1:128。每日三次服用1克红霉素治疗无效。因此，给予患者初始剂量为50 - 100毫克的泼尼松，随后剂量减少。在此治疗过程中肺功能恢复正常，影像学表现和抗体滴度下降。因此，如果在排除急性感染性肺炎且红霉素治疗失败后，高度怀疑由嗜肺军团菌引起的纤维化肺泡炎，应尝试使用皮质类固醇进行治疗。
