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以巨大肺大疱合并新型冠状病毒肺炎感染形式表现的结节病

Sarcoidosis Presenting as a Giant Pulmonary Bulla With Concurrent COVID-19 Infection.

作者信息

Krishnan Sathish, Naumaan Anam, Pararath Gopalakrishnan Venu

机构信息

Division of Pulmonary and Critical Care Medicine, Community Health Network, Indianapolis, IN, USA.

Division of Pathology, Community Health Network, Indianapolis, IN, USA.

出版信息

J Investig Med High Impact Case Rep. 2025 Jan-Dec;13:23247096251340738. doi: 10.1177/23247096251340738. Epub 2025 May 8.

DOI:10.1177/23247096251340738
PMID:40340503
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12062588/
Abstract

Sarcoidosis is a systemic granulomatous disease that predominantly affects the lungs. However, its presentation as a giant pulmonary bulla is exceptionally rare. Its association with COVID-19 has raised new concerns regarding disease exacerbation and misdiagnosis. We report a case of a 38-year-old man who developed a large left lower lobe bulla in the context of recent COVID-19 infection. Initial misinterpretation of the bulla as loculated pneumothorax nearly led to an unnecessary chest tube placement. A subsequent thoracotomy with lobectomy revealed nonnecrotizing granulomas, confirming sarcoidosis. The patient showed spontaneous remission without requiring treatment. This case highlights the importance of multidisciplinary discussions in atypical lung presentations to prevent mismanagement.

摘要

结节病是一种主要累及肺部的全身性肉芽肿性疾病。然而，其表现为巨大肺大疱极为罕见。它与新型冠状病毒肺炎（COVID-19）的关联引发了对疾病加重和误诊的新担忧。我们报告一例38岁男性病例，该患者在近期感染COVID-19的情况下出现左肺下叶巨大肺大疱。最初将肺大疱误诊为局限性气胸，险些导致不必要的胸腔置管。随后的开胸肺叶切除术显示为非坏死性肉芽肿，确诊为结节病。患者未经治疗即出现自发缓解。该病例强调了在非典型肺部表现中进行多学科讨论以防止管理不当的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8cfd/12062588/3814c508ce78/10.1177_23247096251340738-fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8cfd/12062588/6eaa94692a22/10.1177_23247096251340738-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8cfd/12062588/58278f7f31e3/10.1177_23247096251340738-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8cfd/12062588/3814c508ce78/10.1177_23247096251340738-fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8cfd/12062588/6eaa94692a22/10.1177_23247096251340738-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8cfd/12062588/58278f7f31e3/10.1177_23247096251340738-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8cfd/12062588/3814c508ce78/10.1177_23247096251340738-fig3.jpg

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本文引用的文献

1
Sarcoidosis following COVID infection: A case series.新冠感染后结节病：病例系列
Respirol Case Rep. 2023 Oct 13;11(11):e01231. doi: 10.1002/rcr2.1231. eCollection 2023 Nov.
2
New-onset lung sarcoidosis, an adverse event by COVID-19 or a sign of convalescence; a case report.新发肺结节病，是新冠病毒感染的不良事件还是康复迹象；一例病例报告。
Clin Case Rep. 2023 May 10;11(5):e7339. doi: 10.1002/ccr3.7339. eCollection 2023 May.
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Development of bullous lung disease in a patient with severe COVID-19 pneumonitis.一名重症新型冠状病毒肺炎患者发生大疱性肺疾病。
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Unusual presentations of COVID-19 pneumonia on CT scans with spontaneous pneumomediastinum and loculated pneumothorax: A report of two cases and a review of the literature.CT 扫描中伴有自发性纵隔气肿和局限性气胸的 COVID-19 肺炎的不典型表现：两例病例报告及文献复习。
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Spontaneous Pneumothorax Following COVID-19 Pneumonia.新冠病毒肺炎后自发性气胸
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Mediastinal Emphysema, Giant Bulla, and Pneumothorax Developed during the Course of COVID-19 Pneumonia.在 COVID-19 肺炎的病程中发生了纵隔气肿、巨大肺大疱和气胸。
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Sarcoidosis as a rare cause for symmetrical giant bullous disease.结节病作为对称性巨大疱疹样皮肤病的罕见病因。
BMC Pulm Med. 2017 May 30;17(1):88. doi: 10.1186/s12890-017-0429-z.
8
Pulmonary sarcoidosis: typical and atypical manifestations at high-resolution CT with pathologic correlation.肺部肉样瘤病：高分辨率 CT 的典型和非典型表现及与病理学的相关性。
Radiographics. 2010 Oct;30(6):1567-86. doi: 10.1148/rg.306105512.
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Sarcoidosis: an underrecognised cause for bullous lung disease?结节病：大疱性肺病的一个未被充分认识的病因？
Eur Respir J. 2009 Oct;34(4):999-1001. doi: 10.1183/09031936.00084609.
10
A young patient with a minimal smoking history presents with bullous emphysema and recurrent pneumothorax.一名吸烟史极短的年轻患者出现了大疱性肺气肿和复发性气胸。
Chest. 2007 Jul;132(1):338-43. doi: 10.1378/chest.06-2987.