Bayle J Y, Nesme P, Béjui-Thivolet F, Loire R, Guérin J C, Cordier J F
Service de Pneumologie, Hôpital de la Croix Rousse, Lyon, France.
Eur Respir J. 1995 Feb;8(2):322-6. doi: 10.1183/09031936.95.08020322.
We report on two women presenting with cough and fever, 4 and 7 months, respectively, after starting breast radiation therapy following surgery for breast carcinoma. Chest roentgenogram and computed tomographic (CT) scan demonstrated alveolar opacities, initially limited to the pulmonary area next to the irradiated breast, but later migrating within both lungs. Intra-alveolar granulation tissue was found in transbronchial lung biopsies. Corticosteroid treatment resulted in dramatic clinical improvement, together with complete clearing of the pulmonary opacities on chest imaging. However, clinical and imaging relapses occurred when corticosteroids were withdrawn too rapidly; with further improvement when they were reintroduced. The reported cases clearly differ from radiation pneumonitis. They were fairly typical of cryptogenic organizing pneumonitis, also called idiopathic bronchiolitis obliterans organizing pneumonia, with the exception of the radiation therapy, partially affecting the lung, which had been performed within the previous months. Since focal radiation therapy involving the lung may induce diffuse bilateral lymphocytic alveolitis, we hypothesize that this may "prime" the lung to further injury, leading to cryptogenic organizing pneumonitis.
我们报告了两名女性患者，她们分别在乳腺癌手术后开始接受乳房放射治疗4个月和7个月后出现咳嗽和发热症状。胸部X线片和计算机断层扫描（CT）显示肺泡混浊，最初局限于受照射乳房旁的肺部区域，但后来在双肺内迁移。经支气管肺活检发现肺泡内肉芽组织。皮质类固醇治疗使临床症状显著改善，胸部影像学上肺部混浊也完全消失。然而，当皮质类固醇迅速撤药时，临床和影像学症状复发；重新使用后症状进一步改善。报道的这些病例明显不同于放射性肺炎。除了前几个月进行的部分影响肺部的放射治疗外，它们相当典型地表现为隐源性机化性肺炎，也称为特发性闭塞性细支气管炎伴机化性肺炎。由于涉及肺部的局部放射治疗可能诱发弥漫性双侧淋巴细胞性肺泡炎，我们推测这可能使肺部“致敏”，导致进一步损伤，进而引发隐源性机化性肺炎。
