Ngo Jennifer, Wenger Mathew, Chee Alex
Department of Medicine University of Calgary Calgary Canada.
South Health Campus Hospital Calgary Canada.
Respirol Case Rep. 2022 Aug 29;10(10):e01028. doi: 10.1002/rcr2.1028. eCollection 2022 Oct.
The presence of bilirubin in the sputum is uncommon but, when present, is most commonly associated with the presence of bronchobiliary fistula, which could be associated with a number of underlying conditions. However, the finding of bilioptysis without bronchobiliary fistula is uncommon, with one associated mechanism postulated to involve increased capillary membrane permeability. This case report describes a patient presenting with bilioptysis while being medically managed with prednisolone for severe alcoholic hepatitis. The patient developed hospital-acquired pneumonia during her hospitalization associated with bilioptysis, resulting in progressive respiratory failure requiring ventilatory support. Alcohol-related pulmonary dysfunction alters pulmonary immune processes, leading to increased susceptibility to pulmonary infection and disrupting the basal alveolar epithelial membrane, thus increasing permeability. This patient's findings were in the absence of a bronchobiliary or bronchopleural fistula, and we hypothesize that increased capillary membrane permeability was contributory to the bilioptysis in this case.
痰液中出现胆红素并不常见，但一旦出现，最常见于支气管胆管瘘，而支气管胆管瘘可能与多种潜在疾病相关。然而，无支气管胆管瘘的胆汁咳出情况并不常见，一种推测的相关机制涉及毛细血管膜通透性增加。本病例报告描述了一名正在接受泼尼松龙治疗严重酒精性肝炎的患者出现胆汁咳出的情况。该患者在住院期间并发医院获得性肺炎，与胆汁咳出相关，导致进行性呼吸衰竭，需要通气支持。酒精相关的肺功能障碍会改变肺部免疫过程，导致肺部感染易感性增加，并破坏肺泡基底上皮膜，从而增加通透性。该患者的检查结果显示不存在支气管胆管瘘或支气管胸膜瘘，我们推测毛细血管膜通透性增加是导致该病例中胆汁咳出的原因。
