Inutsuka Yu, Yanagihara Toyoshi, Matsumoto Kotaro, Yoneda Reiko, Hashisako Mikiko, Ogo Naruhiko, Asoh Tatsuma, Maeyama Takashige
Respiratory Medicine, Hamanomachi Hospital, Fukuoka, JPN.
Surgery, Hamanomachi Hospital, Fukuoka, JPN.
Cureus. 2022 Jan 4;14(1):e20916. doi: 10.7759/cureus.20916. eCollection 2022 Jan.
We describe a case of a 77-year-old male with idiopathic pulmonary fibrosis (IPF) complicated by lung adenocarcinoma and organizing pneumonia (OP). On initial examination, physical examination revealed fine crackles in both sides of his chest. There were no physical findings suggestive of collagen disease. Blood tests showed no elevation of C-reactive protein, and lactate dehydrogenase and Krebs von den Lungen-6 (KL-6) were within normal limits. A high-resolution CT (HRCT) of the chest showed multiple ground-glass opacities (GGOs) in both lungs, with consolidation and traction bronchiectasis in the left lower lobe. Although a bronchoscopy was performed, no diagnosis could be made. Bronchoalveolar lavage showed elevated lymphocytes, and treatment with prednisolone was started for the possibility of OP. Subsequent chest X-ray and chest CT showed worsening of the shadows over time, and shortness of breath on exertion progressed. Surgical lung biopsy revealed IPF complicated by adenocarcinoma and OP. Although the patient was treated with pemetrexed and carboplatin combination therapy, respiratory failure progressed, and palliative care was decided. There is no report of IPF complicated by adenocarcinoma and OP, and early surgical lung biopsy may be important for diagnosis.
我们描述了一例77岁男性患者，患有特发性肺纤维化（IPF），并发肺腺癌和机化性肺炎（OP）。初诊时，体格检查发现双侧胸部有细湿啰音。没有提示胶原病的体格检查发现。血液检查显示C反应蛋白未升高，乳酸脱氢酶和克雷伯斯-冯-登-伦根-6（KL-6）在正常范围内。胸部高分辨率CT（HRCT）显示双肺多发磨玻璃影（GGO），左下叶有实变和牵拉性支气管扩张。尽管进行了支气管镜检查，但未能确诊。支气管肺泡灌洗显示淋巴细胞升高，因可能存在OP而开始使用泼尼松龙治疗。随后的胸部X线和胸部CT显示阴影随时间推移逐渐加重，劳力性呼吸困难进展。外科肺活检显示IPF并发腺癌和OP。尽管患者接受了培美曲塞和卡铂联合治疗，但呼吸衰竭仍进展，遂决定进行姑息治疗。目前尚无IPF并发腺癌和OP的报道，早期外科肺活检可能对诊断很重要。
