Iwata M, Ida M, Oda S, Takeuchi E, Nakamura Y, Horiguchi T, Sato A
Department of Respiratory Medicine, Haibara General Hospital, Shizuoka, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1996 Nov;34(11):1271-6.
A 62-year-old man was referred to our department because of exertional dyspnea and a 6-year history of coughing and sputum production. He had never smoked, and had had an operation for chronic paranasal sinusitis. Coarse crackles and rhonchi were audible over both lower lung fields. The cold hemagglutinin titers were high. pulmonary function tests showed airflow obstruction, and a sputum culture revealed Hemophilus influenzae A chest X-ray film and a CT scan showed diffuse micronodular shadows in the centrilobular regions, mild ectasis of bronchioles mainly in the lower lung fields, and mild hyperinflation. A specimen of lung tissue was obtained by thoracoscopic biopsy, and histologic examination showed bronchiolitis obliterans, with bronchiolar narrowing or obliteration due to submucosal fibrosis and inflammation. Rheumatoid arthritis was diagnosed 14 months after the operation. The patient was treated with clarithromycin for 3 years. Respiratory symptoms were relieved and pulmonary function gradually improved.
一名62岁男性因劳力性呼吸困难以及6年的咳嗽、咳痰病史转诊至我科。他从不吸烟，曾因慢性鼻窦炎接受手术。双下肺可闻及粗湿啰音和干啰音。冷凝集素效价较高。肺功能检查显示气流受限，痰培养发现甲型流感嗜血杆菌。胸部X线片和CT扫描显示小叶中心区域弥漫性微结节影，主要在下肺野的细支气管轻度扩张，以及轻度肺过度充气。通过胸腔镜活检获取肺组织标本，组织学检查显示闭塞性细支气管炎，因黏膜下纤维化和炎症导致细支气管狭窄或闭塞。术后14个月诊断为类风湿关节炎。患者接受克拉霉素治疗3年。呼吸症状缓解，肺功能逐渐改善。
