Serial Pulmonary Function Tests in a Patient with Cryptogenic Organizing Pneumonia-A Case Report

原因不明器質化肺炎的病人的一系列肺功能變化－病例報告

沈聲燁(Sheng-Yeh Shen) ； 林清基(Ching-Chi Lin) ； 陳碧芳(Be-Fong Chen)

《胸腔醫學》 21卷5期 (2006/10) Pp. 444-451

https://doi.org/10.29806/TM.200610.0007

摘要

原因不明器質化肺炎(cryptogenic organizing pneumonia)是一種影響小型氣道的罕見疾病。息肉狀的肉芽組織阻塞了小型氣道，肺泡管及肺泡的管徑，而且泡沫狀的巨噬細胞通常會存在於空腔中。原因不明器質化肺炎，顧名思義，無法找到發生原因或是與以下原因相關：感染，藥物，肺內吸入，放射線，骨髓移植，肺臟或心肺移植，膠原血管疾病或是發炎疾病。
我們報告一個病例：83歲老先生咳嗽無痰已經有兩個月，之後發現活動性氣促。胸部X光顯示雙側下肺野不規則網狀變化及air bronchogram。經驗性抗生素治療並不能改善他的氣促及缺氧。胸部電腦斷層可看出兩邊後下側肺部支氣管旁肺浸潤及毛玻璃顯像。開胸活體肺部切片診斷為阻塞性細支氣管炎合併器質化肺炎。
經給予劑量為每公斤每天1毫克的口服prednisolone，病人的臨床症狀及影像有明顯進步。之後prednisolone。減量至每日10毫克，而病人仍然維持正常活動量而沒有不適症狀。

關鍵字

原因不明器質化肺炎cryptogenic organizing pneumonia ； 阻塞性細支氣管炎合併器質化肺炎bronchiloitis obliterans organizing pneumonia ； 肺功能

並列摘要

Cryptogenic organizing pneumonia (COP) is a rare disorder involving the small airways. Polypoid granulation tissues that occupy the lumen of the small airways, alveolar ducts, and alveoli, and foamy macrophages are commonly present in the airspaces.
We report an 83-year-old male who had a nonproductive cough for 2 months, after which exertional dyspnea developed. A chest radiograph revealed an infiltration with an irregular reticular pattern with air bronchograms in both lower lungs. Empiric antibiotics failed to improve his dyspnea and hypoxia. Chest computed tomography (CT) revealed peribronchial infiltrates with ground glass opacities in both posterior basal lungs. Wedge lung biopsy resulted in a diagnosis of bronchiolitis obliterans organizing pneumonia. As no etiology could be found, the applicable diagnosis was COP. Oral prednisolone, 1mg/kg/day resulted in dramatic clinical and radiographic improvement. Even after the prednisolone was tapered to 10mg/day, the patient remained asymptomatic with normal daily activity.

並列關鍵字

cryptogenic organizing pneumonia ； bronchiolitis obliterans organizing pneumonia ； pulmonary function test