Department of Respiratory Medicine, The First Hospital of Jilin University, Changchun, China.
Department of Respiratory Medicine, The First Hospital of Jilin University, Changchun, China.
J Infect Public Health. 2023 Apr;16(4):526-530. doi: 10.1016/j.jiph.2023.02.013. Epub 2023 Feb 13.
Diffuse cystic lung disease (DCLD) is a complex disease that can be caused by various reasons. Although the chest CT scan plays a vital role in suggesting the etiology of DCLD, it is apt to lead to misdiagnosis simply based on the CT image of the lung. Here, we report a rare case of DCLD caused by tuberculosis and misdiagnosed as pulmonary Langerhans cell histiocytosis (PLCH). A 60-year-old female DCLD patient with a long-term smoking history was admitted to the hospital because of a dry cough and dyspnea, and the chest CT scan showed diffuse irregular cysts in both lungs. We considered the patient to be PLCH. To alleviate dyspnea, we chose to give her intravenous glucocorticoids. However, she developed a high fever during the use of glucocorticoids. We performed flexible bronchoscopy and bronchoalveolar lavage. Mycobacterium tuberculosis (specific sequence reads: 30) was detected in BALF. She was finally diagnosed with pulmonary tuberculosis. Tuberculosis infection is one of the rare causes of DCLD. We have discovered thirteen similar cases by searching Pubmed and Web of Science. For DCLD patients, glucocorticoids should not be used blindly unless the existence of a tuberculosis infection is ruled out. TBLB for pathology and bronchoalveolar lavage fluid (BALF) for microbiological detection are helpful for diagnosis.
弥漫性囊性肺病（DCLD）是一种复杂的疾病，可能由多种原因引起。虽然胸部 CT 扫描在提示 DCLD 的病因方面起着至关重要的作用，但仅凭肺部 CT 图像很容易导致误诊。在这里，我们报告了一例由结核病引起的罕见 DCLD 病例，误诊为肺朗格汉斯细胞组织细胞增生症（PLCH）。一名 60 岁的女性 DCLD 患者，有长期吸烟史，因干咳和呼吸困难住院，胸部 CT 扫描显示双肺弥漫性不规则囊肿。我们考虑患者为 PLCH。为缓解呼吸困难，我们选择给予她静脉注射糖皮质激素。然而，在使用糖皮质激素期间，她出现高热。我们进行了支气管镜检查和支气管肺泡灌洗。在 BALF 中检测到结核分枝杆菌（特异序列读取：30）。她最终被诊断为肺结核。结核感染是 DCLD 的罕见原因之一。通过在 Pubmed 和 Web of Science 上搜索，我们发现了 13 例类似病例。对于 DCLD 患者，除非排除结核感染的存在，否则不应盲目使用糖皮质激素。经支气管镜肺活检（TBLB）进行病理学检查和支气管肺泡灌洗液（BALF）进行微生物学检测有助于诊断。
