Ishihara K, Tomioka H, Hasegawa T, Okazaki M, Katakami N, Sakamoto H, Iwasaki H, Umeda B, Nakai H
Nihon Kyobu Shikkan Gakkai Zasshi. 1989 Nov;27(11):1355-61.
A female case of Japanese summer-type hypersensitivity pneumonitis who was a smoker developed in chronic respiratory failure several years later. Biopsy specimen on first admission showed findings of granulomatous bronchioloalveolitis distributed in the center of secondary lobules. Pulmonary function studies demonstrated restrictive disease with high RV% and low airway conductance. In spite of steroid therapy, dyspnea persisted and the same symptoms were found on next summer. Six years later symptoms of chronic respiratory failure and cor pulmonale developed. Chest X-Ray showed dilated pulmonary artery, cardiomegaly and overinflation without apparent fibrosis. Hypoxemia and hypercapnia were also seen on blood gas analysis. Pulmonary function was unchanged compared to the findings on first admission. Since then long term oxygen therapy was started. It was thought that irreversible small airway disease caused by hypersensitivity pneumonitis was attributable to cor pulmonale and chronic respiratory failure because of her smoking habit and long period of exposure to antigen. As a patient with summer type hypersensitivity pneumonitis always has a possibility of chronic disease developing after long term exposure to antigen, such as a farmer's lung, the cessation of exposure to antigen by complete cleaning up of the patient's environment or moving out were considered to be important.
一名日本夏季型过敏性肺炎女性患者，是吸烟者，数年后发展为慢性呼吸衰竭。首次入院时的活检标本显示细支气管肺泡炎呈肉芽肿性，分布于次级肺小叶中央。肺功能研究显示为限制性疾病，残气量百分比高，气道传导率低。尽管进行了类固醇治疗，但呼吸困难持续存在，次年夏天出现相同症状。六年后出现慢性呼吸衰竭和肺心病症状。胸部X线显示肺动脉扩张、心脏扩大和过度充气，无明显纤维化。血气分析也显示低氧血症和高碳酸血症。与首次入院时的检查结果相比，肺功能无变化。此后开始长期氧疗。由于她的吸烟习惯和长期接触抗原，认为过敏性肺炎引起的不可逆小气道疾病是导致肺心病和慢性呼吸衰竭的原因。由于夏季型过敏性肺炎患者长期接触抗原（如农民肺）后总有发展为慢性病的可能性，因此通过彻底清理患者环境或搬离来停止接触抗原被认为很重要。
