儿童闭塞性支气管炎合并闭塞性细支气管炎伴机化性肺炎一例并文献复习

Bronchitis obliterans associated with bronchiolitis obliterans with organizing pneumonia in a child and literature review

目的 探讨闭塞性支气管炎合并闭塞性细支气管炎伴机化性肺炎儿童临床-影像-病理学特点.方法 回顾1例南京医科大学附属南京儿童医院呼吸科2012-2013年收治的肺炎支原体肺炎后合并闭塞性细支气管炎伴机化性肺炎的儿童闭塞性支气管炎患儿临床诊治情况、影像学表现、组织病理学所见,并复习相关文献.结果 10岁女童,反复咳嗽、咯黄脓痰、不规则发热1个月,左下肺呼吸音低并有管状呼吸音;肺部影像示左下肺支气管扩张、扭曲,远端肺不张.纤维支气管镜见支气管黏膜滤泡增生,左下支气管亚段以下闭塞、痰栓.肺组织切面灰红、灰黄,局灶肉质变,管腔内少量黄色分泌物;镜下见肺组织纤维结缔组织增生、见泡沫细胞及Masson小体.肺炎支原体抗体IgM＞1∶160.经红霉素等抗感染,纤维支气管镜灌洗后一度改善,但因病情反复最终行左肺切除,术后恢复良好.检索1990年1月-2016年1月CNKI中文数据库及PubMed,以“闭塞性支气管炎”与“闭塞性细支气管炎伴机化性肺炎”同时检索,没有检索到国内外任何文献.结论 闭塞性支气管炎合并闭塞性细支气管炎伴机化性肺炎患儿表现为发热及呼吸道症状迁延不愈,肺部呼吸音低、管状呼吸音;肺炎支原体抗体阳性.影像学表现支气管扩张、远端肺不张.病理学检查可见肺纤维结缔组织增生、Masson小体.经肺叶切除病情好转.

Objective To investigate the clinical-radiologic-pathologic features of bronchitis obliterans that complicated with bronchiolitis obliterans with organizing pneumonia （BOOP）.Method The clinical manifestations,characteristic imaging and pathology of a case with pediatric Mycoplasma pneumoniae pneumonia （MPP） complicated with bronchitis obliterans and BOOP were summarized and relative articles were reviewed.Result A 10-year-old girl complained of recurrent paroxysmal cough and episodes of wheezing with exercise,productive of yellowish sputum,irregular fever for 1 month presented with lower breath sounds of left lower lobe and localized tubular breath sounds.Lung imaging studies showed atelectasis of the left lower lobe with proximal bronchiectasis.Follicular hyperplasia of bronchial mucosa,subsegmental bronchial obliterans and sputum bolt were detected via Fiberoptic bronchoscopy.Pathological sections of lung tissue revealed greyish yellow or red color,localized carnification,and yellowish intraluminal excretions.Microscopy displayed fiber connective tissue hyperplasia,foam cells and Masson bodies.Serologic examination detected the titer of MP-IgM antibody over 1∶ 160.Erythromycin,corticosteroids and bronchoalveolar lavage were applied to the patient,leading to improved condition for a certain period.However,the symptoms relapsed and surgical resection of left lung had to be carried out to achieve a convalescence eventually.No literature was found from the search results of 〉Bronchitis obliterans ＆quot; and ＆quot; cryptogenic organizing pneumonia＆quot; in the China National Knowledge Infrastructure （CNKI） and PubMed database during the period from January 1990 to January 2016.Conclusion The patient who had Bronchitis obliterans complicated with BOOP suffered from persisting fever and respiratory symptoms,and showed lower breath sounds and localized tubular breath sounds.MP-IgM was positive.Lung image showed atelectasis with proximal bronchiectasis.Fiber connective tissue hyperplasia and Masson bodies were found in pathologic examinations.The patient was recovering after surgical resection of the affected side of the lung.