Kofler Thomas, Daikeler Thomas, Savic Prince Spasenija, Holzmann Yvonne, Bremerich Jens, Tamm Michael, Jahn Kathleen
Department of Pneumology, University Hospital Basel, Switzerland.
Rheumatology Division, University Hospital Basel, Basel, Switzerland.
Respir Med Case Rep. 2018 May 19;24:138-142. doi: 10.1016/j.rmcr.2018.05.015. eCollection 2018.
A 25 year old woman was referred to our center for further evaluation of an exercise-induced dyspnea. Moreover, the patient suffered from hoarseness and recurrent sinusitis and otitis. After initially finding nothing suspicious, a spiro-ergometry was performed. Interestingly, we saw a relevant limitation of the inspiratory flow-volume curve under maximal exercise load. Further evaluation (in particular the bronchoscopy and the resulting biopsies) led us to the final diagnosis of a granulomatosis with polyangiitis. After 4 weeks of an established therapy regime with prednisone and rituximab the prior detected subglottic stenosis and the inspiratory flow-volume curve limitation could no longer detected. We describe a rare differential diagnosis of an exercise-induced asthma and we underline the importance of a multimodal therapy concept. We highlight the critical nature of the flow-volume curve in spiro-ergometry under maximal exercise load. We recommend frequent follow-up control visits to monitor the subglottic stenosis.
一名25岁女性因运动诱发的呼吸困难被转诊至我们中心作进一步评估。此外，该患者还患有声音嘶哑以及复发性鼻窦炎和中耳炎。最初未发现可疑情况后，进行了运动心肺功能测试。有趣的是，我们在最大运动负荷下看到吸气流量-容积曲线存在明显受限。进一步评估（尤其是支气管镜检查及由此获得的活检）使我们最终诊断为肉芽肿性多血管炎。在采用泼尼松和利妥昔单抗的既定治疗方案治疗4周后，先前检测到的声门下狭窄和吸气流量-容积曲线受限情况已无法检测到。我们描述了运动诱发哮喘的一种罕见鉴别诊断，并强调了多模式治疗理念的重要性。我们强调了最大运动负荷下运动心肺功能测试中流量-容积曲线的关键性质。我们建议定期进行随访检查以监测声门下狭窄情况。
