Nakamura K, Hirakata M, Fujii T, Yoshida T, Mimori T, Mukai M, Akizuki M
Department of Medicine, Keio University, School of Medicine, Tokyo.
Ryumachi. 1995 Feb;35(1):9-14.
Three cases with systemic rheumatic diseases who developed lung diseases compatible with BOOP were reported. Underlying diseases of these patients were: RA (1 case), SLE (2 cases). Respiratory symptoms were observed in one case such as dry cough at the time of diagnosis of BOOP. Chest radiography showed multiple infiltrates in 2 cases, bilateral reticular shadow in one case. In one case characteristic finding described as wandering shadow was observed. TBLB was done in 3 cases. Pathohistological findings were compatible with BOOP. Repeated Bacteriological examinations failed to demonstrate specific organisms implicated for lung lesions. Cytological studies of sputum and TBLB specimens were all negative for malignancy. Antibiotic agents including anti-tuberculosis drugs were not effective for pulmonary diseases. Moderate doses of prednisolone were effective in 3 cases. Although the open lung biopsy has been recommended for establishment of diagnosis of BOOP, in patient with systemic rheumatic diseases this invasive procedure is not always easily performed. Further characterizations of clinical and laboratory features are indicated for noninvasive diagnosis of BOOP.
报告了3例患有系统性风湿性疾病且出现符合闭塞性细支气管炎伴机化性肺炎(BOOP)的肺部疾病的病例。这些患者的基础疾病为:类风湿关节炎(RA,1例),系统性红斑狼疮(SLE,2例)。在1例BOOP诊断时观察到呼吸道症状,如干咳。胸部X线检查显示2例有多处浸润影,1例有双侧网状阴影。在1例中观察到被描述为游走性阴影的特征性表现。3例均进行了经支气管肺活检(TBLB)。病理组织学结果符合BOOP。反复的细菌学检查未能证明与肺部病变有关的特定病原体。痰液和TBLB标本的细胞学研究均未发现恶性肿瘤。包括抗结核药物在内的抗生素对肺部疾病无效。中等剂量的泼尼松龙对3例有效。尽管推荐进行开胸肺活检以确诊BOOP,但对于患有系统性风湿性疾病的患者,这种侵入性操作并不总是容易实施。为了对BOOP进行非侵入性诊断,需要进一步明确其临床和实验室特征。