- 期刊
嗜酸性白血球增多型慢性鼻竇炎與重積性氣喘－病例報告
Eosinophilic Chronic Rhinosinusitis and Status Asthmaticus-Case Report
摘要
嗜酸性白血球增多型慢性鼻竇炎（eosinophilic chronic rhinosinusitis, ECRS）為慢性鼻竇炎併鼻息肉（CRSwNP）的一個亞型，常見臨床症狀為嗅覺減退和黏液性鼻涕。相較於其他類型之鼻竇炎，於手術後的鼻息肉復發機率較高，且治療上也傾向使用類固醇。本文報告一典型ECRS於術後合併重積性氣喘之嚴重個案：57歲男性，過去病史有氣喘及慢性鼻竇炎，經多次內視鏡鼻竇手術的病人，回診時於門診主訴嗅覺減退、膿性鼻涕與鼻涕倒流數個月，抽血報告嗜酸性白血球比例升高，頭頸部電腦斷層顯示雙側鼻竇炎復發，故再次入院接受手術。術後之病理切片顯示廣泛嗜酸性白血球浸潤之急性和慢性發炎反應，綜合病史、抽血報告、電腦斷層結果與病理切片，診斷為ECRS。然於術後全身麻醉甦醒拔管後，呼吸狀況及血氧濃度復原不佳轉入加護病房觀察，因併發重積性氣喘，接受緊急環甲膜切開術及後續修正性氣管切開術置入氣切管，經過系列治療最後康復出院。本文分享治療經驗，也回顧ECRS與氣喘的相關病生理機轉與治療方式。
並列摘要
Eosinophilic chronic rhinosinusitis (ECRS) is a subgroup of CRS with nasal polyps (CRSwNP). Hyposmia and viscous nasal discharge are common symptoms of ECRS. Compared to other types of rhinosinusitis, the recurrence rate of nasal polyps in ECRS is higher and would require to be treated with oral or topical glucocorticoid. We reported a case of ECRS complicated with status asthmaticus in a 57-year-old male with history of asthma and CRS, status post endoscopic sinus surgery, who presented to our clinic with hyposmia, purulent nasal discharge and post-nasal dripping for months. Blood tests revealed he was suffering eosinophilia. Computed tomography indicated opacification of upper nasal cavities, ethmoid sinuses, frontal sinuses and sphenoid sinuses, which were compatible with recurrent sinusitis. He was then admitted for navigation-guided revised endoscopic sinus surgery. Pathological examination revealed acute and chronic inflammation with marked infiltration of eosinophils. ECRS was thus diagnosed based on past medical history, blood tests, image studies and pathological results. However, progressive dyspnea and desaturation were noted immediately after extubation and recovery from general anesthesia despite bronchodilator usage. The patient was diagnosed as asthmaticus. Due to failure of reintubation in ICU for bronchospasm, emergent cricothyrotomy followed by revision tracheostomy were performed. The patient's general condition gradually improved over time. In the report, we discuss this case and review the pathophysiology and current treatment of ECRS with asthma.
延伸閱讀
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