Yoshimura N, Nodera H, Ohkouchi M, Atarashi K, Tsukimoto K, Beppu H, Matsubara O, Nakatani Y, Yoshizawa Y
Division of Respiratory Medicine, Hiratsuka Kyosai Hospital, Kanagawa, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1997 Oct;35(10):1067-73.
A 64-year-old woman had been feeding more than 60 pigeons in a coop in her back yard for 35 years. Diffuse reticulonodular shadows were found on a chest radiograph obtained as part of an annual check-up eight years before admission to the hospital. She was given a tentative diagnosis of idiopathic pulmonary fibrosis and was observed. She was admitted to our hospital because she noticed dry coughing and shortness of breath. A chest CT scan revealed segmentally distributed honeycombing and bronchi-bronchioloectasis. Tests for IgA and IgG antibodies to extracts of pigeon droppings in serum samples and in samples of bronchoalveolar lavage fluid were strongly positive, as were tests for lymphocyte blastogenic responses to samples of pigeon serum Examination of lung-biopsy specimens obtained by video-assisted thoracoscopic surgery revealed bronchiolitis, alveolitis, and honeycombing in a centrilobular distribution. The patient was given a diagnosis of pigeon-breeder's disease. Chronic hypersensitivity pneumonitis without acute episodes might be misdiagnosed as idiopathic interstitial pneumonia or bronchiectasis, as happened in this case. The possibility of chronic hypersensitivity pneumonitis should be considered when patients are suspected to have pulmonary fibrosis. It is important to obtain the detailed information on past or current avian contact, working history, and the home environment.
一名64岁女性在自家后院的鸽舍中喂养60多只鸽子长达35年。入院前8年进行年度体检时，胸部X光片发现弥漫性网状结节阴影。她被初步诊断为特发性肺纤维化并接受观察。因出现干咳和气短症状，她入住我院。胸部CT扫描显示有节段性分布的蜂窝状改变和支气管 - 细支气管扩张。血清样本和支气管肺泡灌洗液体样本中针对鸽粪提取物的IgA和IgG抗体检测呈强阳性，对鸽血清样本的淋巴细胞增殖反应检测也呈阳性。通过电视辅助胸腔镜手术获取的肺活检标本检查显示小叶中心分布的细支气管炎、肺泡炎和蜂窝状改变。该患者被诊断为养鸽者病。无急性发作的慢性过敏性肺炎可能会被误诊为特发性间质性肺炎或支气管扩张，本病例就是如此。当怀疑患者患有肺纤维化时，应考虑慢性过敏性肺炎的可能性。获取有关过去或当前与禽类接触、工作史和家庭环境的详细信息很重要。
