Department of General Internal Medicine, Kameda Medical Center, Japan.
Department of Pulmonology, Kameda Medical Center, Japan.
Intern Med. 2024 Jan 1;63(1):113-117. doi: 10.2169/internalmedicine.1240-22. Epub 2023 May 17.
An 83-year-old man presented with chronic dyspnea, and chest X-ray showed bilateral pleural effusion. Right thoracentesis revealed lymphocyte-predominant exudate with no malignancy; bacterial and mycobacterial cultures were negative. Thoracoscopy via the right chest and a biopsy of the same site were performed; these showed lymphoplasmacytic infiltration and fibrosis, ruling out malignancy or tuberculosis. We decided to start corticosteroid therapy for the diagnosis of idiopathic lymphocytic pleuritis (ILP). The patient was discharged after clinical improvement, and steroids were tapered off. An early diagnosis by thoracoscopy and the exclusion of other diseases are important for initiating steroid therapy in patients with ILP.
一位 83 岁男性因慢性呼吸困难就诊，胸部 X 线片显示双侧胸腔积液。右侧胸腔穿刺抽液显示以淋巴细胞为主的渗出液，无恶性肿瘤；细菌和分枝杆菌培养均为阴性。行右侧胸腔镜检查和同一部位活检，结果显示淋巴浆细胞浸润和纤维化，排除了恶性肿瘤或结核。我们决定开始皮质类固醇治疗，以诊断特发性淋巴细胞性胸膜炎（ILP）。患者在临床症状改善后出院，逐渐减少类固醇用量。对 ILP 患者进行早期诊断和排除其他疾病对于开始皮质类固醇治疗非常重要。
