[膀胱内注射卡介苗致间质性肺炎1例]。

K. Naoki, K. Yamaguchi, K. Soejima, T. Aoki, T. Inoue, N. Satou, H. Shimada, K. Fukunaga, H. Kudo, M. Kanazawa
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引用次数: 4

摘要

1例61岁男性浅表性膀胱癌患者在主诉血尿后被发现,经膀胱内卡介苗治疗3次。此后发现肝功能不全,住进我院。入院3天后,患者主讲劳累时呼吸困难伴严重低氧血症,胸片异常表现为双侧肺密度大。我们进行了支气管镜检查,获得了支气管肺泡灌洗液(BALF)和肺活检标本(TBLB)。在BALF中,细胞总数明显增加,特别是CD4/CD8比值高的淋巴细胞。TBLB标本显示病变为大量非干酪化肉芽肿。我们未能在痰、尿、血和BALF中获得明确的卡介苗证据。相反,我们发现卡介苗的淋巴细胞刺激试验(DLST)呈强烈阳性。根据这些发现,诊断为可能由卡介苗过敏引起的严重间质性肺炎。抗结核药物和类固醇脉冲治疗后口服相对低剂量的类固醇可改善异常情况,包括胸部x线片表现和低氧血症。淋巴细胞数量和CD4/CD8比值也明显降低。膀胱内注射卡介苗可诱导严重间质性肺炎,导致BALF细胞组分发生过渡性变化。
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 interstitial pneumonia induced by intravesical administration of bacillus Calmette-Guerin (BCG)].
A 61-year-old man with superficial bladder cancer, which was detected after he complained of hematuria, was treated three times with intravesical BCG administration. Since liver dysfunction was detected thereafter, he was admitted to our hospital. Three days after admission, he complained of dyspnea on exertion associated with severe hypoxemia, as well as abnormal findings on chest X-ray, i.e. extensive bilateral lung densities. We performed bronchoscopic examination and obtained bronchoalveolar lavage fluid (BALF) and lung biopsy specimens (TBLB). In the BALF, a marked increase in the total cell number, particularly lymphocytes with a high CD4/CD8 ratio was noted. TBLB specimens revealed the lesions to be numerous non-caseating granulomas. We failed to obtain definite evidence of BCG in the sputum, urine, blood, and BALF. Instead, we found that a lymphocyte stimulation test for BCG (DLST) was strongly positive. Based on these findings, severe interstitial pneumonia probably induced by hypersensitivity against BCG, was diagnosed. Anti-tuberculous agents, and steroid-pulse therapy followed by oral administration of relatively low dose of steroid ameliorated the abnormal conditions, including chest X-ray film findings and hypoxemia. The population of lymphocytes and CD4/CD8 ratio in the BALF were reduced as well. Serious interstitial pneumonia was induced by the intravesical administration of BCG, which resulted in transitional changes in the BALF cell component.
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