1例D-青霉胺治疗后出现闭塞性细支气管炎的类风湿关节炎病例

[A case of rheumatoid arthritis with obstructive bronchiolitis appearing after D-penicillamine therapy].

作者信息

Honda T, Hachiya T, Hayasaka M, Morita M, Nakagawa S, Kusama Y, Kubo K, Sekiguchi M, Kobayashi O

机构信息

First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto City, Japan.

出版信息

Nihon Kyobu Shikkan Gakkai Zasshi. 1993 Sep;31(9):1195-200.

PMID:8255035

Abstract

A 56-year-old woman was diagnosed as having rheumatoid arthritis in 1983. She was treated with D-penicillamine in addition to non-steroid anti-inflammatory drugs from April 1990. In August she noticed shortness of breath on exertion. Chest X-ray films showed bilateral interstitial shadows, and chest CT revealed bilateral multiple wedge-shaped shadows extending distally. Blood gas analysis showed severe hypoxemia and pulmonary function tests demonstrated decreased %VC, FEV1.0% and diffusion capacity. Open lung biopsy specimens revealed infiltration of inflammatory cells and fibrotic change in the walls of bronchioles. She was diagnosed as having obstructive bronchiolitis. Corticosteroid therapy and discontinuation of D-penicillamine therapy stopped the progression of her symptoms, and she was discharged on corticosteroid maintenance treatment and home oxygen therapy.

摘要

一名56岁女性于1983年被诊断为类风湿性关节炎。自1990年4月起，她除了接受非甾体抗炎药治疗外，还使用青霉胺进行治疗。8月时，她发现活动后气短。胸部X光片显示双侧间质阴影，胸部CT显示双侧多个楔形阴影向远端延伸。血气分析显示严重低氧血症，肺功能测试显示肺活量百分比（%VC）、第一秒用力呼气容积百分比（FEV1.0%）和弥散能力下降。开胸肺活检标本显示细支气管壁有炎性细胞浸润和纤维化改变。她被诊断为闭塞性细支气管炎。皮质类固醇治疗和停用青霉胺治疗阻止了她症状的进展，她出院后接受皮质类固醇维持治疗和家庭氧疗。