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尸检对改善患者护理至关重要:一例经尸检诊断为晚期特发性间质性肺炎的罕见病例报告及致命结局

Autopsies are indispensable in the advancement of patient care: Report of an unusual presentation and fatal outcome of an autopsy-diagnosed case of advanced idiopathic interstitial pneumonia.

作者信息

Abada Evi, Raval Kunil

机构信息

Department of Pathology, Wayne State University, Detroit, MI 48201, USA.

出版信息

Lung India. 2020 Jul-Aug;37(4):333-335. doi: 10.4103/lungindia.lungindia_570_19.

Abstract

Idiopathic interstitial pneumonias (IIPs) are a group of fibrosing lung disorders conferring significant morbidity and mortality to patients. Most patients with IIP first present with dyspnea and/or cough. Here, we report the case of a 53-year-old male who presented with severe abdominal pain and weight loss of approximately 100 pounds of 3-month duration. Symptoms of mild dyspnea and cough were obtained during additional history taking. Physical examination and computed tomography of the chest were suggestive of pneumonia, and he was placed on multiple antibiotics but developed worsening respiration that necessitated hyperbaric oxygen and died after 10 days. Histopathological examination of autopsy lung specimen, revealed severe lung damage secondary to a mixed IIP pattern of diffuse alveolar damage, superimposed on extensive interstitial fibrosis, with features of honeycombing, consistent with advanced interstitial/end-stage lung disease. This case typifies an unusual and fatal presentation of IIP, which may be useful in clinical practice.

摘要

特发性间质性肺炎(IIP)是一组导致患者出现严重发病和死亡的肺纤维化疾病。大多数IIP患者最初表现为呼吸困难和/或咳嗽。在此,我们报告一例53岁男性病例,该患者出现严重腹痛和体重减轻约100磅,病程3个月。在进一步询问病史时了解到有轻度呼吸困难和咳嗽症状。体格检查和胸部计算机断层扫描提示为肺炎,他接受了多种抗生素治疗,但呼吸状况恶化,需要高压氧治疗,10天后死亡。尸检肺标本的组织病理学检查显示,继发于弥漫性肺泡损伤的混合性IIP模式导致严重肺损伤,叠加广泛的间质纤维化,并伴有蜂窝状特征,符合晚期间质性/终末期肺病。该病例代表了IIP一种不寻常的致命表现形式,可能对临床实践有帮助。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e01/7507932/1b62c6d7d52a/LI-37-333-g001.jpg

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