Pääkkö P, Sutinen S, Anttila S, Autio-Harmainen H, Sormunen R, Hakala M, Jouppila J
Department of Pathology, University of Oulu, Finland.
Pathol Res Pract. 1988 Feb;183(1):46-53. doi: 10.1016/S0344-0338(88)80158-4.
A 47-year-old housewife presented with nonproductive cough, progressive breathlessness and intermittent fever during gold treatment, originally prescribed for seropositive polyarthritis, which later fulfilled the criteria for systemic lupus erythematosus (SLE). An open lung biopsy showed abundant interstitial edema with mononuclear inflammatory cells and some eosinophils, and slight bronchiolitis. The picture was nonspecific but suggestive of hypersensitivity pneumonitis. Electron microscopy revealed splitting and local disappearance of the basal laminae of the alveolar capillaries, venules and alveolar epithelium. This injury was confirmed by immunohistochemical staining for type IV collagen and laminin, the major components of basal laminae. In most macrophages there was lysosomal electron dense granular material, i.e. aurosomes, which gave the spectrum of gold in electron microprobe analysis. After the gold treatment was stopped the pulmonary symptoms gradually decreased during several months and no permanent lung disease remained. Whereas the pulmonary manifestation could have been due to her underlying disease we discuss in this study the possibility of its being gold induced.
一名47岁的家庭主妇在接受金制剂治疗期间出现干咳、进行性呼吸困难和间歇性发热。最初使用金制剂是治疗血清反应阳性的多关节炎，后来该患者符合系统性红斑狼疮（SLE）的诊断标准。开放性肺活检显示大量间质水肿，伴有单核炎性细胞和一些嗜酸性粒细胞，并有轻度细支气管炎。此表现不具有特异性，但提示为过敏性肺炎。电子显微镜检查显示肺泡毛细血管、小静脉和肺泡上皮的基底层出现分裂和局部消失。通过对基底层主要成分IV型胶原和层粘连蛋白进行免疫组化染色，证实了这种损伤。在大多数巨噬细胞中有溶酶体电子致密颗粒物质，即金体，在电子微探针分析中呈现出金的光谱。停止金制剂治疗后，肺部症状在数月内逐渐减轻，未遗留永久性肺部疾病。虽然肺部表现可能归因于其基础疾病，但在本研究中我们探讨了金制剂诱发该表现的可能性。
