隐源性机化性肺炎反复误诊为社区获得性肺炎

Cryptogenic Organizing Pneumonia Repeatedly Misdiagnosed as Community Acquired Pneumonia

目的探讨隐源性机化性肺炎(cryptogenic organizing pneumonia,COP)的诊治要点,以减少误诊。方法回顾分析我科收治的1例误诊为社区获得性肺炎(community acquired pneumonia,CAP)的COP临床资料,并复习相关文献。结果本例因发现双肺反复渗出性病灶5个月就诊。病程中多次就诊当地医院行胸部CT扫描诊断为CAP,反复予抗感染治疗无效。入我院后查血常规未见明显异常,胸部CT检查示两肺上叶、右肺下叶多发炎性病灶;纤维支气管镜未见异常;B超检查未见全身浅表淋巴结增大;肿瘤标志物检测、痰病原学及感染生物标志物检查均(-)。后行CT引导下经皮肺穿刺活检病理检查,并结合影像学表现,确诊为COP,予大剂量甲泼尼龙琥珀酸钠冲击后序贯口服治疗,病情好转出院。随访1年病情稳定。结论临床遇及肺部多发渗出性实变患者,病程较长,常规抗感染治疗无效,尤其对糖皮质激素治疗敏感时应高度警惕COP,及时行纤维支气管镜或CT引导下经皮肺活检病理检查,以减少误诊误治。

Objective To study the diagnosis and treatment of cryptogenic organizing pneumonia （COP） , so as to re- duce misdiagnosis rate. Methods Clinical data of one case of community acquired pneumonia misdiagnosed as COP in our hospital was retrospectively analyzed, with a review of literature. Results The patient had been hospitalized 5 months before for lung exudation. CT scanning in a local hospital supported diagnosis of CAP and anti-infection therapy failed to respond. Our hospital chest CT scan showed multiple exudation in both lungs ; bronchoseopy checked patency of every lumen ; B type ul- trasound revealed no enlarged superficial lymph nodes; lung biopsy and pathological examination showed COP, the patient＇s symptoms were significantly relieved after high dose glucocorticoid pulse therapy for one week and at the same time, most le- sions were absorbed. Conclusion For multiple pulmonary exudative consolidation patients with long course of disease, re- fractory to conventional anti infection treatment, especially for the glucocorticoid sensitivity, COP should be considered and fi- beroptic bronchoscopy or CT guided percutaneous lung biopsy should be performed in order to reduce the misdiagnosis and mis- treatment rates.