Miyazaki E, Sugisaki K, Shigenaga T, Matsumoto T, Kita S, Inobe Y, Tsuda T
Department of Internal Medicine, Oita Medical University, Japan.
Am J Respir Crit Care Med. 1995 Feb;151(2 Pt 1):541-3. doi: 10.1164/ajrccm.151.2.7842218.
We present the diagnostically challenging case of an 18-yr-old Japanese woman who presented with fever, nonproductive cough, and acute respiratory distress. Her chest radiograph showed diffuse interstitial infiltrates and bilateral pleural effusions. Eosinophilic pneumonia was diagnosed by bronchoalveolar lavage and transbronchial lung biopsy. She was treated with minocycline, and was discharged in 2 wk. However, within 3 h of returning home, she experienced a recurrence. She showed positive immediate, Arthus, and delayed-type skin reactions and positive lymphocyte stimulation test to an antigen derived from Trichosporon terrestre, which was isolated from dust in her home. In addition, a bronchoprovocation test with the same antigen caused a nonproductive cough with fever, hypoxemia, and peripheral eosinophilia. We concluded that T. terrestre was the causal agent of the acute eosinophilic pneumonia.
我们报告了一例诊断颇具挑战性的病例，患者为一名18岁的日本女性，出现发热、干咳和急性呼吸窘迫症状。她的胸部X光片显示弥漫性间质浸润和双侧胸腔积液。通过支气管肺泡灌洗和经支气管肺活检诊断为嗜酸性粒细胞性肺炎。她接受了米诺环素治疗，并在2周后出院。然而，回家后3小时内，她病情复发。她对从家中灰尘中分离出的土曲霉抗原表现出即刻、阿瑟斯和迟发型皮肤反应阳性，淋巴细胞刺激试验也呈阳性。此外，用相同抗原进行支气管激发试验引发了干咳伴发热、低氧血症和外周血嗜酸性粒细胞增多。我们得出结论，土曲霉是急性嗜酸性粒细胞性肺炎的病原体。
