Reijula K, Sutinen S, Tuuponen T, Lahti R, Kärkölä P
Eur J Respir Dis. 1983 Nov;64(8):625-9.
We report a case of extrinsic allergic bronchiolo-alveolitis associated with handling of mouldy lichen. The patient had periodic dyspnoea, cough and mucoid sputum, and a micronodular infiltration of both lungs with slight restrictive ventilatory insufficiency. An open lung biopsy showed interstitial inflammation and fibrosis with sarcoid granulomas and angiitis. The symptoms disappeared during long term corticosteroid therapy, but reappeared every year when the patient participated in the handling of lichen (Cladonia alpestris). Precipitating antibodies against Aspergillus fumigatus, A. umbrosus, and Thermoactinomyces vulgaris, were detected in the patient's serum, and against a mixture of fungi including A. terreus, Rhizopus spp., Cladosporium spp., and Penicillium spp., isolated from mouldy lichen storage boxes. After she retired, her symptoms disappeared and the lung function tests showed a slight improvement. In Northern Finland, farmers generally participate in lichen collection. Antigens from mouldy hay and from mouldy lichen may represent a double occupational hazard for them.
我们报告一例与处理发霉地衣相关的外源性过敏性细支气管肺泡炎病例。患者有周期性呼吸困难、咳嗽和黏液样痰，双肺有微小结节浸润，伴有轻度限制性通气功能不全。开胸肺活检显示间质性炎症和纤维化，伴有结节病肉芽肿和血管炎。症状在长期皮质类固醇治疗期间消失，但每年患者参与处理地衣（高山石蕊）时都会再次出现。在患者血清中检测到针对烟曲霉、荫蔽曲霉和普通嗜热放线菌的沉淀抗体，以及针对从发霉地衣储存箱中分离出的包括土曲霉、根霉属、枝孢属和青霉属在内的混合真菌的沉淀抗体。她退休后，症状消失，肺功能测试显示略有改善。在芬兰北部，农民普遍参与地衣采集。来自发霉干草和发霉地衣的抗原可能对他们构成双重职业危害。
