Kano S, Kobayashi H, Kiryu T, Kawaguchi S, Tanaka H, Uwabe Y, Nagata N
Third Department of Internal Medicine, National Defense Medical College, Saitama, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1994 Jun;32(6):566-70.
A 52-year-old man was admitted to another hospital with complaints of fever and dyspnea. Chest roentgenogram revealed bilateral widespread infiltrative opacities, and laboratory examinations showed severe hypoxia, hepatic injury and acute renal failure. In addition, hemosputum and eruption appeared, and he was transferred to our department because of the development of multi-organ failure. Moreover, about 2 weeks prior to admission, a budgerigar he had been breeding died. Although the treatment was supportive therapy alone, the abnormal shadow on chest roentgenogram and laboratory findings improved markedly. Thereafter, we made the diagnosis of psittacosis, because the serum titer of a complement fixation test against Chlamydia rose from 1:8 on admission to 1:512 after 2 weeks. On admission, PMN and lymphocyte populations increased in bronchoalveolar lavage fluid (BALF), and 2 weeks later lymphocytes alone increased markedly. Thereafter, we observed lymphocytosis in serial BALF findings for 12 weeks. These findings indicate that lymphocyte alveolitis persisted long after the pneumonia had resolved. Moreover, Ga scintigraphy also revealed accumulation in the filed of shadows which had been absorbed and disappeared on the chest roentgenogram. These results suggest that lymphocytes play a leading role in immune host defenses and that immunological reactivity is prolonged in psittacosis.
一名52岁男性因发热和呼吸困难入住另一家医院。胸部X线片显示双侧广泛浸润性阴影，实验室检查显示严重缺氧、肝损伤和急性肾衰竭。此外，出现了咯血和皮疹，由于多器官功能衰竭的进展，他被转到我们科室。此外，入院前约2周，他饲养的一只虎皮鹦鹉死亡。尽管仅进行了支持性治疗，但胸部X线片上的异常阴影和实验室检查结果明显改善。此后，我们诊断为鹦鹉热，因为针对衣原体的补体结合试验血清滴度从入院时的1:8升至2周后的1:512。入院时，支气管肺泡灌洗（BALF）液中的中性粒细胞和淋巴细胞数量增加，2周后仅淋巴细胞显著增加。此后，我们在连续12周的BALF检查结果中观察到淋巴细胞增多。这些发现表明，肺炎消退后淋巴细胞性肺泡炎持续了很长时间。此外，镓闪烁扫描也显示在胸部X线片上已吸收和消失的阴影区域有放射性聚集。这些结果表明，淋巴细胞在免疫宿主防御中起主导作用，并且鹦鹉热中的免疫反应性会延长。
