Fata F, Rathore R, Schiff C, Herzlich B C
Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA.
South Med J. 1997 Feb;90(2):227-30. doi: 10.1097/00007611-199702000-00013.
Bronchiolitis obliterans organizing pneumonia (BOOP) preceding polymyositis is rare. In this report, a 51-year-old patient with fever, nonproductive cough, and dyspnea had bilateral basal interstitial infiltrates on chest roentgenogram. Open lung biopsy was consistent with BOOP. Prednisone therapy led to improvement, but 8 weeks later, fever, cough, and weakness of the arms and legs developed because the patient had not been compliant with the prednisone regimen. The creatine kinase (CK), the macrophage inflammatory protein (MIP-1), and the tumor necrosis factor (TNF-alpha) were elevated. Anti-Jo-1 antibody was not present. Quadriceps femoris muscle biopsy was compatible with polymyositis. After a second course of corticosteroid therapy, the patient became afebrile, the dyspnea resolved, the pulmonary infiltrates decreased, and the muscle strength improved. The serum CK, MIP-1, and TNF-alpha levels declined significantly. This is only the second reported case of BOOP preceding polymyositis. Patients with idiopathic BOOP should have follow-up for the possible development of connective tissue disorders including polymyositis.
闭塞性细支气管炎伴机化性肺炎（BOOP）先于多发性肌炎出现的情况较为罕见。在本报告中，一名51岁的患者出现发热、干咳和呼吸困难，胸部X线片显示双侧肺底部间质浸润。开胸肺活检结果符合BOOP。泼尼松治疗后病情有所改善，但8周后，由于患者未遵守泼尼松治疗方案，出现发热、咳嗽以及手臂和腿部无力。肌酸激酶（CK）、巨噬细胞炎性蛋白（MIP-1）和肿瘤坏死因子（TNF-α）升高。未检测到抗Jo-1抗体。股四头肌活检结果符合多发性肌炎。在进行第二个疗程的皮质类固醇治疗后，患者体温恢复正常，呼吸困难缓解，肺部浸润减少，肌肉力量增强。血清CK、MIP-1和TNF-α水平显著下降。这是第二例报告的BOOP先于多发性肌炎出现的病例。特发性BOOP患者应进行随访，以监测包括多发性肌炎在内的结缔组织疾病的可能发展。
