Sawaguchi H, Tanaka A, Chihara J, Nagasaka Y, Nakajima S
Fourth Department of Internal Medicine, Kinki University School of Medicine.
Nihon Kyobu Shikkan Gakkai Zasshi. 1996 Jun;34(6):694-9.
A 43-year-old man who had been treated for bronchial asthma presented with an increase in dry coughing and wheezing for one and a half years. In August 1994, the patient noted progressive dyspnea on exertion. A chest radiograph revealed nodular opacity in the right upper lung field. In November 1994, the patient was admitted to Kinki University Hospital with an erythematous rash on the soles of both feet. Examination of a specimen biopsy of the skin lesion revealed granuloma with eosinophil infiltration. Peripheral blood eosinohilia was noted and a bone marrow examination also revealed an increased level of eosinophils. Another chest radiograph revedaled that the nodular opacity had disappeared and a new bilateral pleural effusion was seen. Eosinophils were the predominant cells in the pleural effusion. the patient's condition was further complicated by myocarditis. Allergic granulomatous angitis (Churg-Strauss syndrome) was diagnosed and steroid therapy was started. After the start of steroid therapy, the skin eruption disappered and the myocarditis became less severe. Symptoms of asthma were also well controlled. The eosinophils had hypersegmented unclei and increased expression of adhesion molecules on their surfaces.
一名曾接受支气管哮喘治疗的43岁男性，干咳和喘息加重已持续一年半。1994年8月，患者注意到活动时进行性呼吸困难。胸部X线片显示右上肺野有结节状阴影。1994年11月，患者因双足底出现红斑性皮疹入住近畿大学医院。对皮肤病变进行标本活检检查发现有嗜酸性粒细胞浸润的肉芽肿。外周血嗜酸性粒细胞增多，骨髓检查也显示嗜酸性粒细胞水平升高。另一张胸部X线片显示结节状阴影已消失，出现了新的双侧胸腔积液。嗜酸性粒细胞是胸腔积液中的主要细胞。患者的病情因心肌炎而进一步复杂化。诊断为变应性肉芽肿性血管炎（Churg-Strauss综合征）并开始使用类固醇治疗。开始使用类固醇治疗后，皮疹消失，心肌炎症状减轻。哮喘症状也得到了很好的控制。嗜酸性粒细胞有核分叶过多现象，其表面黏附分子表达增加。
