[结节病并发中枢神经系统多发结节性病变原发性急性肺空化1例]。

Nihon Kyobu Shikkan Gakkai zasshi Pub Date : 1997-12-01
T Nakayama, S Hashimito, K Arai, H Nakazawa, T Horie
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引用次数: 0

摘要

一名20岁男子来我院就诊,主诉头痛和干咳。胸部x线及胸部CT示双侧肺门及纵隔淋巴结肿大,多发空泡,壁薄光滑,弥漫性颗粒影。经支气管活检标本显示结节样肉芽肿。由于胸片未见感染、肺气肿改变、纤维化或囊性支气管扩张改变,因此诊断为结节病的原发性急性肺空化。因患者主诉头痛,行脑电图、CT增强及MRI检查。脑电图显示高电压阵发性慢波及巨大堆积,而脑CT未见异常。t1加权磁共振增强显示多发高强度结节,分布于脑干和脊髓。开始皮质类固醇治疗(60mg /天)。治疗1周后头痛消失。治疗2周后,肺野腔及中枢神经系统结节均消失。因此,皮质类固醇的剂量逐渐减少到5mg /天的维持剂量,没有复发。我们报告一个非常罕见的病例原发性急性肺空化结节病并发多发性结节病变的中枢神经系统。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[A case of primary acute pulmonary cavitation in sarcoidosis complicated by multiple nodular lesions in the central nervous system].

A 20-year-old man visited our hospital complaining of headache and a dry cough. Chest X-ray and chest CT showed bilateral hilar and mediastinal lymphadenopathy, multiple cavitations with thin, smooth walls, and diffuse granular shadows. A transbronchial biopsy specimen revealed sarcoid granuloma. Primary acute pulmonary cavitation of sarcoidosis was diagnosed, since there was no evidence of infection, emphysematous change, fibrotic or cystic bronchiectatic change on chest X-ray. EEG, contrast enhancement of brain CT scans and MRI were performed because the patient complained of headache. EEG showed a high voltage paroxysmal slow wave and giant build-up, whereas brain CT showed no abnormalities. T1-weighted MRI with gadolinium enhancement showed multiple high intensity nodules in the convexity, brain stem, and spinal cord. Corticosteroid therapy (60 mg/day) was started. After 1 week of treatment, the headache ceased. After 2 weeks of treatment, both the cavities in the lung field's and the nodules in the central nervous system disappeared. Therefore, the dose of corticosteroids was gradually reduced to a maintenance dose of 5 mg/day, and no relapse was noted. We report a very rare case of primary acute pulmonary cavitation in sarcoidosis complicated by multiple nodular lesions in the central nervous system.

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