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Title: 間質性肺炎の急性増悪を認めた慢性関節リウマチの1剖検例
Other Titles: An autopsy case of rheumatoid arthritis accompanied with acute exacerabation of interstitial pneumonia
Authors: 荒武, 弘一朗 / 江口, 勝美 / 右田, 清志 / 河部, 庸二郎 / 松岡, 直樹 / 富永, 雅博 / 中村, 英樹 / 一瀬, 恭史 / 長瀧, 重信 / 鳥山, 寛
Authors (alternative): Aratake, Koichiro / Eguchi, Katsumi / Migita, Kiyoshi / Kawabe, Yojiro / Matsuoka, Naoki / Tominaga, Masahiro / Nakamura, Hideki / Ichinose, Kyoji / Nagataki, Shigenobu / Toriyama, Kan
Issue Date: 30-Jun-1998
Publisher: 日本臨床免疫学会 / The Japan Society for Clinical Immunology
Citation: 日本臨床免疫学会会誌, 21(3), pp.129-136; 1998
Abstract: 間質性肺炎の急性増悪をきたし,急速な経過をとり呼吸不全で死亡した慢性関節リウマチ(RA)の1剖検例を報告する.症例は57歳女性. 33歳時, RA発症. 41歳時,肺線維症を指摘される.平成8年5月15日より安静時呼吸困難出現.同年6月3日,精査加療のため当科入院となる.入院時,胸部X線上,両側全肺野にびまん性のスリガラス状陰影を認め,高度の呼吸不全を認めた.間質性肺炎の急性増悪を疑い,入院当日より,ステロイドパルス療法を行った.しかし症状改善なく,シクロスポリンの投与を併用するも,呼吸不全は急速に進行して第14病日に死亡した.剖検肺組織では,下葉の一部にHoney comb lung, 肺胞壁の線維化と蜂巣状拡張を認めたが,病変の主体は,著明な炎症細胞の浸潤と肺胞構築の破壊を伴うびまん性の線維化であり,肺胞上皮の剥離や肺胞内出血,一部には硝子膜も認められ, DAD(diffuse alveolar damage)の所見を認めた. / An autopsy case of rheumatoid arthritis (RA) with acute exacerbation of interstitial pneumonia is reported.A 57-year-old woman with longstanding RA was admitted to our hospital because of progressive dyspnea. On chest roentogenogram, diffuse interstitial shadow was confirmed in both lungs. Chest computed tomography (CT) showed difffuse lesion of elevated density of CT level in both lung. She was diagnosed as an acute exacerbation of interstitial pneumonia, and treated by methylpredonisolone pulse therapy (1, 000 mg/day). Although cyclosporin A (2 mg/kg/day) was combined to steroid therapy, she was died of progressive respiratory failure. The histological findings of the lung showed extensive fibrosis with alveolar damage associated with hyaline membranes, edema and hemorrhage in alveolar space.
Keywords: rheumatoid arthritis / interstitial pneumonia / diffuse alveolar damage
URI: http://hdl.handle.net/10069/24071
ISSN: 09114300
Rights: Copyright (c) 1998 日本臨床免疫学会
Type: Journal Article
Text Version: publisher
Appears in Collections:Articles in academic journal

Citable URI : http://hdl.handle.net/10069/24071

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