Yokogawa K, Tanaka H, Mori M, Sasaoka S, Sasaki H, Hirasawa M, Shibusa T, Abe S, Satoh M
Hokkaido Kitami Hospital, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1995 Nov;33(11):1259-64.
A 38-year-old man was seen at another hospital because of bilateral reticulo-nodular shadows on a chest X-ray film at the time of a regular health check-up. Pulmonary tuberculosis was diagnosed, and the patient was treated with antituberculous chemotherapy. The shadow did not improve, and the patient was transferred to our hospital. Bacteriological studies for pyogenic bacteria, mycobacteria, and fungi were all negative. Serum levels of angiotensin-converting enzyme and lysozyme were abnormally high. Examination of a specimen obtained by transbronchial lung biopsy revealed noncaseating epithelioid-cell granuloma associated with severe hyalinization. Sarcoidosis was diagnosed. Chest CT showed multiple nodular opacities, some of which were calcified. Oral steroids were given because the lesion was progressing rapidly. Cavitary lesions appeared during tapering of steroid therapy. Bacteriological and fungal studies were negative and transbronchial lung biopsy showed noncaseating epithelioid-cell granuloma. Therefore, the cavitation within the granuloma with hyalinization may have developed because of steroid therapy, and the calcification may have been caused by postorganizing dystrophy.
一名38岁男性在一次常规健康检查时，因胸部X光片显示双侧网状结节阴影而在另一家医院就诊。诊断为肺结核，患者接受了抗结核化疗。阴影未见改善，遂转至我院。对化脓性细菌、分枝杆菌和真菌的细菌学研究均为阴性。血清血管紧张素转换酶和溶菌酶水平异常升高。经支气管肺活检获取的标本检查显示非干酪样上皮样细胞肉芽肿伴严重玻璃样变。诊断为结节病。胸部CT显示多个结节状混浊影，部分有钙化。由于病变进展迅速，给予口服类固醇治疗。在类固醇治疗减量期间出现了空洞性病变。细菌学和真菌学研究均为阴性，经支气管肺活检显示非干酪样上皮样细胞肉芽肿。因此，肉芽肿内伴有玻璃样变的空洞可能是由于类固醇治疗所致，而钙化可能是由机化后营养不良引起的。
