Matsuo Ayako, Matsumoto Nobuhiro, Kitamura Akiko, Tsubouchi Hironobu, Yanagi Shigehisa, Nakazato Masamitsu
Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine University of Miyazaki Miyazaki Japan.
Respirol Case Rep. 2017 Dec 22;6(2):e00291. doi: 10.1002/rcr2.291. eCollection 2018 Feb.
We report a rare case of desquamative interstitial pneumonia (DIP) with diffuse alveolar haemorrhage (DAH). A 56-year-old man diagnosed with DIP by surgical lung biopsy 2 years ago was admitted to our hospital because of severe acute respiratory failure. The DIP had progressed despite smoking cessation. On admission, the patient appeared extremely ill, and physical examination revealed respiratory distress. The patient required mechanical ventilation. High-resolution computed tomography showed diffuse ground glass opacity in both lungs. The bronchoalveolar lavage fluid was bloody, and numerous haemosiderin-laden alveolar macrophages were detected. Pulse steroid therapy followed by oral prednisolone immediately relieved the respiratory failure and improved the long-term control of the DIP. Paired sera tests confirmed the diagnosis of influenza A/H3N2 virus infection, which was the cause of the DAH. Chronically progressive DIP with acute respiratory failure due to DAH was successfully treated by steroid therapy.
我们报告一例罕见的伴有弥漫性肺泡出血（DAH）的脱屑性间质性肺炎（DIP）。一名56岁男性，2年前经外科肺活检诊断为DIP，因严重急性呼吸衰竭入住我院。尽管戒烟，DIP仍有进展。入院时，患者病情极重，体格检查发现呼吸窘迫。患者需要机械通气。高分辨率计算机断层扫描显示双肺弥漫性磨玻璃影。支气管肺泡灌洗液呈血性，检测到大量含铁血黄素的肺泡巨噬细胞。脉冲类固醇治疗后立即口服泼尼松龙缓解了呼吸衰竭，并改善了DIP的长期控制。配对血清检测确诊为甲型H3N2流感病毒感染，这是DAH的病因。因DAH导致急性呼吸衰竭的慢性进行性DIP通过类固醇治疗成功治愈。
