Kume Hiroaki, Uematsu Manabu, Tomita Hikaru, Fukuhara Atsuro
Center for Allergy and Respiratory Medicine, Nogami Hospital.
Department of Infectious Diseases and Respiratory Medicine, Fukushima Medical University Aizu Medical Center.
Arerugi. 2021;70(10):1391-1397. doi: 10.15036/arerugi.70.1391.
A-68-year-old man, who has allergic rhinitis with peripheral blood eosinophilia, hospitalized because of fever of unknown origin in May 2020. Five days after antibiotics were given, itchy exanthema occurred, followed by gland glass opacity on both lungs with bilateral pleural effusions. Since acute respiratory failure developed, bronchoscopy was hard to carry out. However, this case was considered acute eosinophilic pneumonia induced by antibiotics, based on radiological findings and laboratory data. Therefore, steroid pulse therapy using intravenous administration of methylprednisolone started, and this therapy was effective. Since these chest shadows and hypoxia were disappeared in two weeks, the amount of steroid was gradually reduced, however, eosinophilic pneumonia recurred once during this course. After discharge in June 2020, this patient came to the outpatient department. When oral administration of prednisolone was decreased less than 2.5mg/day, redness and swelling with slight itch were appeared in the left forearm in September 2020. Histological findings from shin biopsy showed that eosinophils excessively invade to the dermis without angiitis. Although flame figure was not observed in the specimen, we considered that this case has developed eosinophilic cellulitis, based on the clinical manifestation and pathological findings. When prednisolone was increased to 30mg/day, these symptoms were improved, and then prednisolone was gradually reduced. After that, recurrences of these diseases did not occur during the observation period. This case may be diagnosed as hypereosinophilic syndrome since eosinophilic pneumonia and eosinophilic cellulitis caused continuously by recruitment of eosinophils to lung and skin.
一名68岁男性，患有过敏性鼻炎且外周血嗜酸性粒细胞增多，于2020年5月因不明原因发热入院。使用抗生素5天后，出现瘙痒性皮疹，随后双肺出现磨玻璃影并伴有双侧胸腔积液。由于出现急性呼吸衰竭，难以进行支气管镜检查。然而，根据影像学检查结果和实验室数据，该病例被认为是由抗生素引起的急性嗜酸性粒细胞性肺炎。因此，开始静脉注射甲泼尼龙进行类固醇冲击治疗，该治疗有效。由于两周内这些肺部阴影和缺氧症状消失，类固醇剂量逐渐减少，但在此过程中嗜酸性粒细胞性肺炎复发了一次。2020年6月出院后，该患者前来门诊就诊。2020年9月，当口服泼尼松龙减少至每日小于2.5mg时，左前臂出现红肿并伴有轻微瘙痒。胫骨活检的组织学检查结果显示，嗜酸性粒细胞过度浸润至真皮层，无血管炎表现。尽管标本中未观察到火焰状图形，但根据临床表现和病理结果，我们认为该病例已发展为嗜酸性粒细胞性蜂窝织炎。当泼尼松龙增加至每日30mg时，这些症状得到改善，随后泼尼松龙逐渐减量。此后，在观察期内这些疾病未再复发。该病例可能被诊断为高嗜酸性粒细胞综合征，因为嗜酸性粒细胞持续募集至肺部和皮肤导致了嗜酸性粒细胞性肺炎和嗜酸性粒细胞性蜂窝织炎。
