Kayser K, Plodziszewska M, Waitr E, Slodkowska J, Altiner M, Gabius H J
Department of Pathology, Thoraxklinik, Heidelberg, Germany.
Respiration. 1998;65(3):214-8. doi: 10.1159/000029265.
This report describes the clinical, radiological, microscopical and ligandohistochemical findings in a 17-year-old woman who suffered from an acute onset of pulmonary hemosiderosis after inhalation of pesticides used for the cultivation of strawberries. She complained of headache, dyspnea, rhinitis, weakness and recurrent severe hemoptysis. Chest radiographs revealed bilateral patchy infiltrates, predominantly in the lower parts of both lungs. The consecutive severe anemia was treated by multiple blood transfusions which were repeated every 4-5 days. Open lung biopsies displayed signs of diffuse hemorrhage with hemosiderin-loaded macrophages, some hyaline membranes, focal fibroid deposits with intermingled histiocytes, mild interstitial fibrosis and focal intra-alveolar calcified bodies surrounded by foreign body giant cells. Analysis of endogenous lectins failed to demonstrate expression of binding capacities for maltose, fucose, mannose, lactose and sialic acid, Neither binding capacities for the macrophage-migration-inhibitory factor nor its presence, as analyzed by labeled sarcolectin, could be detected histochemically. The light microscopical findings are consistent with a longer-lasting diffuse pulmonary hemosiderosis; the presence of calcified bodies and foreign body giant cells (including the ligandohistochemical data) argues for a causal role of inhaled substances. The patient's clinical course improved after cyclophosphamide treatment, which restored her ability to work and released her from the need for recurrent blood transfusions.
本报告描述了一名17岁女性的临床、放射学、显微镜检查和配体组织化学检查结果。该女性在吸入用于草莓种植的农药后急性发作肺含铁血黄素沉着症。她主诉头痛、呼吸困难、鼻炎、虚弱和反复严重咯血。胸部X光片显示双侧斑片状浸润，主要位于双肺下部。连续的严重贫血通过多次输血治疗，每4 - 5天重复一次。开放性肺活检显示有弥漫性出血迹象，伴有含铁血黄素巨噬细胞、一些透明膜、伴有组织细胞的局灶性纤维样沉积物、轻度间质纤维化以及被异物巨细胞包围的局灶性肺泡内钙化小体。对内源性凝集素的分析未能证明其对麦芽糖、岩藻糖、甘露糖、乳糖和唾液酸的结合能力表达。通过标记肌集钙蛋白分析，巨噬细胞迁移抑制因子的结合能力及其存在情况在组织化学上均未检测到。光镜检查结果与持续时间较长的弥漫性肺含铁血黄素沉着症相符；钙化小体和异物巨细胞的存在（包括配体组织化学数据）表明吸入物质起到了因果作用。环磷酰胺治疗后患者的临床病程有所改善，恢复了工作能力，不再需要反复输血。
