Yu Min, Zhong Jiacheng, Bu Xueyong, Tan Xinjuan, Zhan Danting, Hu Xiaoyi, Gu Yingying, Xu Jing, Zhang Peize, Wang Lingwei
Shenzhen People's Hospital, Shenzhen Institute of Respiratory Diseases, Shenzhen, 518055, China.
Shenzhen Key Laboratory of Respiratory Diseases, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518055, China.
Infect Drug Resist. 2022 Aug 4;15:4235-4239. doi: 10.2147/IDR.S367312. eCollection 2022.
The patient was a middle-aged housewife who had been using the household spray for a long time, and the main symptoms were cough and sputum production. Chest CT showed lobar ground-glass opacities (GGOs) with small patchy consolidation in the right middle lobe (RML), specifically, lung tissue pathology showed a large number of foamy cells and scattered multinucleated giant cells. The patient received empirical anti-infective treatment, but no clinical improvement was observed. Laboratory tests, including smears and cultures of sputum, blood and bronchoalveolar lavage fluid (BALF), did not provide clear evidence for pathogenic microorganisms. Therefore, the presumptive diagnosis was exogenous LP (ExLP). After 28 days of prednisone treatment, her symptoms improved, but 2 months later, she presented with a worsening cough, and the GGOs had progressed into lobar consolidation. Transbronchial lung biopsy (TBLB) culture showed mycobacterium tuberculosis (MTB), and lung tissue pathology showed granulomatous inflammation. After anti-tuberculosis treatment, the consolidation in the right middle lobe was gradually absorbed, along with a considerable symptom improvement. The final diagnosis of the patient was MTB infection with an endogenous lipoid pneumonia (EnLP)-like presentation.
The current case highlights that the MTB infection should be considered when pathology shows LP accompanied by scattered multinucleated giant cells.
患者为一名中年家庭主妇，长期使用家用喷雾剂，主要症状为咳嗽和咳痰。胸部CT显示右中叶（RML）有叶性磨玻璃影（GGOs）伴小片状实变，具体而言，肺组织病理学显示大量泡沫细胞和散在的多核巨细胞。患者接受了经验性抗感染治疗，但未观察到临床改善。包括痰液、血液和支气管肺泡灌洗液（BALF）涂片及培养在内的实验室检查未发现致病微生物的确切证据。因此，初步诊断为外源性类脂性肺炎（ExLP）。泼尼松治疗28天后，她的症状有所改善，但2个月后，她咳嗽加重，GGOs进展为叶性实变。经支气管肺活检（TBLB）培养显示结核分枝杆菌（MTB），肺组织病理学显示肉芽肿性炎症。抗结核治疗后，右中叶实变逐渐吸收，症状也有明显改善。患者的最终诊断为MTB感染伴内源性类脂性肺炎（EnLP）样表现。
本例提示，当病理学显示类脂性肺炎伴有散在多核巨细胞时，应考虑MTB感染。
