Cryptogenic Organizing Pneumonia Mimicking Community-Acquired Pneumonia with Acute Respiratory Failure: A Case Report

以類似於社區性肺炎併發急性呼吸衰竭來表現的原因不明器質化肺炎－病例報告

黃俊達(Chun-Ta Huang) ； 張逸良(Yih-Leong Chang) ； 蔡怡汝(Yi-Ju Tsai) ； 古世基(Shih-Chi Ku) ； 余忠仁(Chong-Jen Yu)

《胸腔醫學》 23卷4期 (2008/08) Pp. 297-303

https://doi.org/10.29806/TM.200808.0010

摘要

原因不明器質化肺炎是相當少見的發炎性肺部疾患，其臨床表徵因病人的不同而呈現相當大的差異性，常見的包括持續性的咳嗽、類似感冒的症狀以及運動時的氣促情形，正因為其症狀表現的非特異性，病人常常被延誤診斷。在此，我們報告一位以類似於社區性肺炎合併急性呼吸衰竭來表現的案例，最後經肺部切片確診為原因不明器質化肺炎，類固醇成功地改善此病人的症狀以及胸部X光片上的異常，雖然在減少類固醇的過程當中疾病又復發，但是適度地增加類固醇的劑量仍然順利的讓病人再次改善。本案例點出原因不明器質化肺炎在診斷上有其困難性所在，特別當病人的肺炎表現並不典型時，臨床醫師應該把這個疾病列入鑑別診斷。

關鍵字

社區性肺炎 ； 類固醇 ； 原因不明器質化肺炎

並列摘要

Cryptogenic organizing pneumonia (COP) is a rare idiopathic inflammatory pulmonary disorder. The clinical manifestations of COP vary greatly from case to case, and include persistent cough, flu-like illness and dyspnea on exertion. Patients with COP are often misdiagnosed as having pneumonia, and therefore have a delay in diagnosis. However, the disease responds well to systemic corticosteroids. In this report, we describe a patient who presented with what seemed to be a case of severe community-acquired pneumonia with acute respiratory failure; however COP was eventually diagnosed via an open lung biopsy. Corticosteroids successfully improved the symptoms and resolved the pulmonary lesions. The patient experienced a disease relapse when the dosage of corticosteroids was reduced. The disease was brought under control again after resuming the effective steroid dosage.

並列關鍵字

community-acquired pneumonia ； corticosteroids ； organizing pneumonia