Kamimura M, Katoh O, Kawata H, Kudo K, Yagishita Y, Niino H, Saitoh K, Saitoh A
Department of Pulmonary Medicine, International Medical Center of Japan, Tokyo, Japan.
Nihon Kokyuki Gakkai Zasshi. 1998 Mar;36(3):278-82.
A 72-year-old man was exposed to the sarin gas attack in a Tokyo subway on March 20 th, 1995. After exposure, he noticed eye discomfort, chest tightness, headache and weakness of the lower limbs and oropharyngeal muscles. Despite these symptoms, he visited a hot spring on the same day with his family. On March 25 th, his muscle weakness progressed, and a low grade fever appeared. His muscle weakness disappeared 8 days after exposure to sarin, but respiratory failure rapidly developed, necessitating artificial ventilation within four day after hospitalization on March 28th. Chemotherapy with erythromycin, imipenem/cilastatin, and steroid pulse therapy was begu. PCR and culture of sputum collected by bronchofiberscopy were positive for Legionella pneumophila, serogroup I. His respiratory state improved, but subsequent infection with Pseudomonous aeruginosa. Enterobacter cloacae, and Candida tropicalis/glabrata caused his death 71 days after admission. Oropharyngeal muscle weakness caused by sarin-mediated cholinesterase inhibition was strongly suspected as the cause of hot spring water aspiration. Transbronchial lung biopsy revealed organizing pneumonia with fibrosis. Bronchoscopic findings included redness, edema and fragility of all visible areas of the airway, which was thought to be due to bronchitis caused by Legionellosis.
一名72岁男性在1995年3月20日的东京地铁沙林毒气袭击事件中暴露于毒气中。暴露后，他出现了眼部不适、胸闷、头痛以及下肢和口咽肌肉无力的症状。尽管有这些症状，他仍在当天与家人一起去了温泉浴场。3月25日，他的肌肉无力症状加重，并出现了低热。接触沙林毒气8天后，他的肌肉无力症状消失，但呼吸衰竭迅速发展，在3月28日住院后的四天内就需要进行人工通气。开始使用红霉素、亚胺培南/西司他丁进行化疗以及进行类固醇冲击治疗。通过支气管纤维镜收集的痰液进行聚合酶链反应（PCR）和培养，结果显示嗜肺军团菌血清1型呈阳性。他的呼吸状况有所改善，但随后感染铜绿假单胞菌、阴沟肠杆菌以及热带念珠菌/光滑念珠菌，导致他在入院71天后死亡。强烈怀疑沙林介导的胆碱酯酶抑制引起的口咽肌肉无力是吸入温泉水的原因。经支气管肺活检显示为伴有纤维化的机化性肺炎。支气管镜检查结果包括气道所有可见区域的发红、水肿和脆弱，这被认为是由军团菌病引起的支气管炎所致。
