Nasuhara Y, Kobayashi S, Munakata M, Kawakami Y, Fujita M
First Department of Medicine, School of Medicine, Hokkaido University, Sapporo, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1995 Sep;33(9):1013-8.
Persistent coughing and bloody sputum developed in a 75-year-old man with mycosis fungoides. Chest X-ray films on admission showed combined patterns of alveolar and interstitial shadows in both lung fields. Histological examination of the transbronchial lung biopsy specimen revealed patchy infiltration of mycosis fungoides cells in alveolar septa. VEPA chemotherapy was ineffective against skin lesions and caused bacterial pneumonia, but combined treatment with etoposide (200 mg, once a week) and prednisolone (30 mg, 3 days per week) resulted in remission. The patient has been taking oral etoposide and prednisolone regularly, and has been free of skin and pulmonary lesions for two years. Combined therapy with low-dose etoposide and prednisolone may be worth trying in cases of advanced mycosis fungoides with pulmonary involvement.
一名75岁蕈样肉芽肿男性患者出现持续性咳嗽和咯血痰。入院时胸部X线片显示双肺野有肺泡和间质阴影的混合模式。经支气管肺活检标本的组织学检查显示蕈样肉芽肿细胞在肺泡间隔呈斑片状浸润。VEPA化疗对皮肤病变无效并导致细菌性肺炎，但依托泊苷（200mg，每周一次）和泼尼松龙（30mg，每周3天）联合治疗导致病情缓解。患者一直定期口服依托泊苷和泼尼松龙，且皮肤和肺部病变已两年未发作。对于晚期蕈样肉芽肿合并肺部受累的病例，低剂量依托泊苷和泼尼松龙联合治疗可能值得一试。
