误诊为真菌性肺炎的保乳术后放疗诱导的闭塞性细支气管炎伴机化性肺炎综合征1例并文献复习

One case report of radiotherapy induced BOOP syndrome after breast-conserving therapy patient misdiagnosing as fungal pneumonia and literature review

目的探讨放射治疗诱导的闭塞性细支气管炎伴机化性肺炎（BOOP）的临床表现、影像学特征、危险因素及治疗。方法分析1例确诊为乳腺癌保乳术并放疗后引起的放疗诱导的BOOP综合征患者的临床特点，并结合文献进行复习。结果乳腺癌放疗后引起的放疗诱导的BOOP综合征多发生在乳腺癌保乳手术后放化疗并进行内分泌治疗的患者中，发病率低，50岁以上女性多见，多发生在乳腺癌放疗后12个月内，发热或呼吸道症状超过2周，胸部CT或X线胸片提示放疗区域外的肺部浸润影，同时排除其他发病原因时需考虑该病。确诊需要依靠病理，若病灶进展则考虑用激素治疗。结论对于发热合并肺内浸润影的保乳术并放疗后患者，除考虑宿主免疫功能下降引起的真菌性肺炎、结核及非常见病原体引起的感染性病变外，还需考虑非感染性病变。经验治疗无好转时，仍需考虑胸腔下肺活检，同时仍应慎重使用激素。

Objective To explore the clinical and radiologic features,risk factors,and treatment of radiotherapy induced bronchiolitis obliterans with organizing pneumonia （BOOP） syndrome. Methods One case of radiotherapy induced BOOP syndrome after breast conserving therapy in our hospital was reported, and literatures were also reviewed. Results Radiotherapy induced BOOP syndrome occurs in female breast cancer patients experiencing breast-conserving surgery with eoeurrent endocrine therapy and radiotherapy within 12 months. The clinical features include fever and other respiratory symptoms for over two weeks. Chest CT scan shows pulmonary infiltrates outside the radiation field. Pathologic examination of lung tissue biopsy is required for definitive diagnosis. Corticosteroids can be used when the disease is in progress. Conclusions For female patients with fever and pulmonary infiltrations after breast- conserving surgery and radiotherapy, non-infectious diseases including radiation-induced BOOP syndrome should be considered in addition to uncommon infectious diseases such as fungal pneumonia and tuberculosis. If no improvement is noted following empirical treatment, lung biopsy is needed. Glucocortieoid therapy should be cautiously performed.