Diffuse Alveolar Hemorrhage- A Case Report and Literature Review

瀰漫性肺泡出血－病例報告與文獻回顧

鄧崇山(Soong-Sun Tang) ； 王逸熙(Yi-Hsi Wang) ； 林孟志(Meng-Chih Lin) ； 黃純真(Shun-Chen Huang)

《胸腔醫學》 19卷5期 (2004/10) Pp. 388-393

https://doi.org/10.29806/TM.200410.0012

摘要

瀰漫性肺泡出血是罕見症狀。它通常與全身性自體免疫疾病有相關，例如血管炎，結締組織疾病，抗基底膜抗體疾病，以及與藥物或感染接觸有關。由於瀰漫性肺泡出血的臨床症狀並無特殊性，所以其診斷常被延遲。我們報告一個瀰漫性肺泡出血病例，其初始症狀以呼吸困難，血痰，和肺部X光兩側肺泡型浸潤來表現。病人經由支氣管鏡檢查確定診斷及使用血漿減除術和脈衝治療後，病情得以改善，並且迅速脫離呼吸器。依據腎臟病理切片和抗中性粒細胞胞漿抗體(p-ANCA)陽性反應，確定診斷為microscopic polyangiitis。這份報告主要強調支氣管肺泡沖洗液對瀰漫性肺泡出血診斷之重要性，以及診斷後類固醇開始治療的時機。

關鍵字

瀰漫性肺泡出血 ； 抗中性粒細胞胞漿抗體 ； 支氣管肺泡沖洗液

並列摘要

Diffuse alveolar hemorrhage (DAH) is a rare but fulminant syndrome. It is usually associated with systemic autoimmune diseases such as vasculitis, connective tissue disease, and anti-basement membrane antibody disease, and can accompany drug exposure or infection. Because of its non-specific clinical presentations, the diagnosis of DAH may be missed. Herein, we report a patient with DAH who initially presented with acute respiratory failure, hemosputum, and a bilateral alveolar radiographic pattern of chest infiltration. The patient was weaned off mechanical ventilation after bronchoscopic diagnosis of DAH and treatment with plasmapheresis and pulse therapy. Microscopic polyangiitis was confirmed by renal biopsy and a positive test using perinuclear antineutrophil cytoplasmic autoantibody. The present case highlights the importance of bronchoalveolar lavage and prompt initiation of steroid therapy following diagnosis.

並列關鍵字

diffuse alveolar hemorrhage ； perinuclear antineutrophil cytoplasmic autoantibody ； bronchoalveolar lavage