Kitamura Y, Motoi M, Terada T
Second Department of Pathology, Faculty of Medicine, Tottori University, Yonago, Japan.
Pathol Int. 1998 Jul;48(7):536-41. doi: 10.1111/j.1440-1827.1998.tb03945.x.
An autopsy case of ancient sarcoidosis with severe fibrosis in the liver and heart was reported. The patient was a 61-year-old female when she died, 12 years after the onset of sarcoidosis. Cervical lymph node biopsy at 49 years demonstrated non-necrotizing sarcoid granuloma, and laboratory data were compatible with sarcoidosis. Liver and heart failure were observed clinically, and because of heart failure a pacemaker was implanted. She died of septic shock at 61 years. At autopsy, the liver demonstrated cirrhotic severe fibrosis, cholestasis, and acute cholangitis without mechanical bile duct obstruction. In the heart, severe fibrosis was observed, and infectious foci of candida infection were observed on the cardiac valves. Although both liver and heart did not show typical sarcoid granuloma, fibrosis was thought to be due to sarcoidosis because no other causes of liver and heart fibrosis were identified clinically or pathologically. There were systemic foci of candida infection, and she died of sepsis due to candida infection. It was speculated that immunological impairment induced candida infection. This case seems to be a rare and important case of ancient sarcoidosis.
报告了一例肝脏和心脏出现严重纤维化的陈旧性结节病尸检病例。患者死亡时61岁，结节病发病12年后。49岁时颈部淋巴结活检显示非坏死性结节病肉芽肿，实验室数据与结节病相符。临床上观察到肝脏和心力衰竭，因心力衰竭植入了起搏器。她61岁时死于感染性休克。尸检时，肝脏显示肝硬化严重纤维化、胆汁淤积和急性胆管炎，无机械性胆管梗阻。心脏中观察到严重纤维化，心脏瓣膜上观察到念珠菌感染的病灶。尽管肝脏和心脏均未显示典型的结节病肉芽肿，但由于临床和病理上均未发现肝脏和心脏纤维化的其他原因，故认为纤维化是由结节病引起的。存在全身性念珠菌感染病灶，她死于念珠菌感染导致的败血症。推测免疫功能损害诱发了念珠菌感染。该病例似乎是一例罕见且重要的陈旧性结节病病例。
