Successful Treatment of Lipoid Pneumonia with Steroid-A Case Report and Literature Review

類脂性肺炎是由於肺部油脂堆積而造成的少見疾病。診斷的方式主要是依據臨床病史、影像學表現及支氣管肺泡灌洗液分析等。我們在此報告一名四十六歲男性在誤吸柴油後引發咳嗽、發燒及肋膜痛等症狀，入院時的胸部X光顯示右中下肺野實質性變化，故初步診斷為吸入性肺炎並投予抗生素治療。支氣管鏡檢查發現右中下肺葉分支有殘留的黃色油滴，但細胞學檢查及微生物培養皆無任何發現。抗生素治療後胸部X光仍無明顯改善，胸部電腦斷層顯示右中肺葉異質性密度的實質化病灶，而電腦斷層導引切片顯示壞死性發炎，追蹤支氣管鏡檢查顯示局部黏膜的發炎反應仍相當明顯。投予類固醇（Prednisolone 30 mg/day）治療後，追蹤顯示臨床症狀及胸部X光皆有明顯的改善，且無明顯的副作用或併發症。因此，對於類脂性肺炎的治療必須有詳細的病史及診斷，類固醇的使用可能有不錯的幫助。

關鍵字

類脂性肺炎；肺炎；支氣管鏡

並列摘要

Lipoid pneumonia is an uncommon disease that results from pulmonary accumulation of a fat-like component. The diagnosis is based on clinical history, radiologic presentation and bronchoalveolar lavage (BAL) sample analysis. We report the case of a 46-year-old male who presented with cough, fever and pleuritic chest pain after diesel oil aspiration. Chest radiograph on admission revealed consolidation in the right lower lung field; an antibiotic was administered to treat aspiration pneumonia. Bronchoscopy revealed some oily, transparent, yellowish fluid in the right lower bronchus, but culture and cytology of BAL fluid showed negative results. The follow-up chest radiograph revealed no obvious improvement after antibiotic treatment. Chest computed tomography (CT) revealed consolidation in the right middle lobe with heterogeneous density, and CT-guided biopsy revealed necrotizing inflammation. A follow-up bronchoscopy showed mucosal inflammation. Steroid was administered to treat the lipoid pneumonia and inflammation, and obvious improvement of the clinical symptoms and radiologic manifestations was seen. No specific adverse effect or complication was noted during therapy. In patients with lipoid pneumonia, careful history-taking and diagnosis are important. Steroid is effective for these patients.

並列關鍵字

lipoid pneumonia ； pneumonia ； bronchoscopy

國際替代計量

Successful Treatment of Lipoid Pneumonia with Steroid-A Case Report and Literature Review

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