Hara Ryo, Watanabe Satoshi, Murase Yuya, Ueda Tsukasa, Muto Atsushi, Kase Kazumasa, Takeda Yoshihiro, Terada Nanao, Koba Hayato, Yamamura Kenta, Nanjo Shigeki, Tambo Yuichi, Ohkura Noriyuki, Abo Miki, Hara Johsuke, Yano Seiji
Department of Respiratory Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan.
Department of Respiratory Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan.
Chest. 2025 Jul;168(1):e3-e7. doi: 10.1016/j.chest.2025.02.024.
A 72-year-old man with progressive dyspnea was referred to our hospital for evaluation of diffuse lung disease. His medical history was unremarkable except for a 20-year history of smoking 20 cigarettes per day. Abnormal findings were first identified on a chest radiograph during a routine medical checkup 11 months earlier. Chest CT scan showed diffuse ground-glass opacities with basilar predominant distribution and some areas of alveolar consolidation predominantly in the lower lobes. Based on clinical and radiographic findings, the patient was initially diagnosed with interstitial lung disease and treated with IV methylprednisolone pulse followed by oral prednisolone, but his condition did not improve. To exclude the possibility of infectious lung disease, empirical antibiotics were administered; however, the patient showed no clinical improvement. Subsequent treatments, including additional methylprednisolone pulses and immunosuppressive agents such as tacrolimus and cyclophosphamide, also failed to yield any significant benefit. His dyspnea progressively worsened, and home oxygen therapy was initiated 4 months before referral. Because of his deteriorating condition despite maximal medical therapy, he was referred to our hospital for comprehensive evaluation.
一名72岁男性，因进行性呼吸困难被转诊至我院，以评估弥漫性肺疾病。除了有20年每天吸20支烟的吸烟史外，他的病史无特殊。11个月前的一次常规体检胸部X线片首次发现异常。胸部CT扫描显示弥漫性磨玻璃影，以基底部分布为主，部分肺泡实变区域主要位于下叶。根据临床和影像学表现，患者最初被诊断为间质性肺疾病，并接受静脉注射甲泼尼龙冲击治疗，随后口服泼尼松龙，但病情无改善。为排除感染性肺疾病的可能性，给予经验性抗生素治疗；然而，患者临床症状未改善。随后的治疗，包括额外的甲泼尼龙冲击治疗以及他克莫司和环磷酰胺等免疫抑制剂治疗，也均未取得明显疗效。他的呼吸困难逐渐加重，在转诊前4个月开始接受家庭氧疗。尽管接受了最大程度的药物治疗，但他的病情仍在恶化，因此被转诊至我院进行全面评估。
