Kondo T, Tanigaki T, Suzuki H, Tamaya S, Ohta Y, Yamabayashi H
Department of Medicine, School of Medicine, Tokai University, Kanagawa, Japan.
Jpn J Med. 1989 Mar-Apr;28(2):212-5. doi: 10.2169/internalmedicine1962.28.212.
The patient was a 67-year-old male. A diagnosis of sarcoidosis was made both by transbronchial lung biopsy and by scalene node biopsy. The findings of his chest roentgenogram were categorized as the group II. There were no symptoms during follow-up period of one year at the out-patient clinic with no medication. The chest X-ray findings of the patient were slowly progressive. Intractable hiccup developed one year after his first visit to the hospital. With administration of prednisolone, serum angiotensin converting enzyme level decreased promptly, and the incidence of the hiccup attack decreased. As the dose of prednisolone was tapered, the hiccup recurred. All the drugs used for hiccup including quinidine sulfate and metoclopramide was not effective. A thoracic CT revealed slight enlargement of mediastinal lymph nodes. A brain CT and a brain MRI demonstrated no abnormalities. Acetazolamide, which induces acidosis in brain extra-cellular fluid, worsened the symptoms. As prednisolone was given again, infiltrates on the chest roentgenogram began to resolve and the incidence of hiccup decreased. We concluded that the long-standing hiccup observed in this patient may be brought by the lesion in central nervous system due to sarcoidosis.
患者为一名67岁男性。经支气管肺活检和斜角肌淋巴结活检均确诊为结节病。其胸部X线检查结果被归类为II组。在门诊随访的一年期间未用药，无任何症状。该患者的胸部X线表现呈缓慢进展。首次就诊一年后出现顽固性呃逆。给予泼尼松龙后，血清血管紧张素转换酶水平迅速下降，呃逆发作次数减少。随着泼尼松龙剂量逐渐减少，呃逆复发。所有用于治疗呃逆的药物，包括硫酸奎尼丁和甲氧氯普胺均无效。胸部CT显示纵隔淋巴结轻度肿大。脑部CT和脑部MRI均未显示异常。乙酰唑胺可导致脑外液酸中毒，使症状加重。再次给予泼尼松龙后，胸部X线片上的浸润影开始消退，呃逆发作次数减少。我们得出结论，该患者长期呃逆可能是由结节病累及中枢神经系统所致。
