Burke G W, Carrington C B, Strauss R, Fink J N, Gaensler E A
JAMA. 1977 Dec 19;238(25):2705-8.
Allergic alveolitis (hypersensitivity pneumonitis) developed in two patients who were exposed to home humidifiers contaminated by thermophilic actinomycetes. Diagnosis was difficult because severe dyspnea was chronic and not easily associated with specific environmental exposure. Furthermore, chest roentgenograms were normal for long periods despite severe physiologic abnormalities. After several years of disabling symptoms, open lung biopsy findings suggested allergic alveolitis rather than sarcoidosis because a mononuclear interstitial infiltrate overshadowed the granulomas. Also, plasma cells were prominent and there was an intense bronchiolitis. Cultures of the humidifier water grew thermophilic organisms to which the patient's sera formed precipitins. Both patients experienced notable subjective and objective improvement following removal of the contaminated appliances. The ultrastructure of alveolar macrophages and basement membranes was similar to that described in animal models, suggesting cell-mediated hypersensitivity in the patients.
两名接触了被嗜热放线菌污染的家用加湿器的患者患上了过敏性肺泡炎（超敏性肺炎）。诊断较为困难，因为严重的呼吸困难呈慢性，且不易与特定的环境暴露相关联。此外，尽管存在严重的生理异常，但胸部X线片在很长一段时间内都正常。在出现数年致残症状后，开胸肺活检结果提示为过敏性肺泡炎而非结节病，因为单核间质浸润掩盖了肉芽肿。此外，浆细胞显著，且存在严重的细支气管炎。加湿器水培养出嗜热生物，患者血清对其形成沉淀素。移除受污染的器具后，两名患者在主观和客观方面都有显著改善。肺泡巨噬细胞和基底膜的超微结构与动物模型中描述的相似，提示患者存在细胞介导的超敏反应。
