一個類固醇治療反應良好的間質性肺炎案例

10.6666/ClinMed.202011_86(5).0122

張佳平；劉至民；羅力瑋

間質性肺炎（interstitial lung disease） ； 隱源性器質性肺炎（cryptogenic organizing pneumonia） ； 類固醇（steroid, prednisolone, methylprednisolone）

臨床醫學月刊

86卷5期（2020 / 11 / 27）

683 - 689

繁體中文

隱源性器質性肺炎（cryptogenic organizing pneumonia）為特發性間質肺炎（idiopathic interstitial pneumonia）中表現為急性／亞急性的一種，盛行率約為每十萬人少於兩人，常發生於50至60歲之間的成人，其初步診斷仰賴胸部X光與電腦斷層上具“波動性的多發性結節狀肺實質化（fluctuating multifocal nodular parenchymal consolidation）＂，確切診斷則需要肺部切片取得病理診斷。隱源性器質性肺炎在臨床上的重要性在於其預後良好，與多數間質性肺炎（interstitial lung disease）不同，經由適當的類固醇治療能使病灶快速緩解，雖然部分病患在治療停止後會復發需要延長治療，但絕大多數病患最終都能得到長久的緩解。這次分享的案例起始表現為急性失償性心衰竭（acute decompensated heart failure）合併雙側肺水腫與雙側肋膜積液，在適當治療緩解肺水腫及肋膜積液後，病情未有明顯改善且胸部X光上出現雙側肺門旁肺間質浸潤，進一步更在胸部電腦斷層中看到毛玻璃樣浸潤及肺門旁實質化。排除非典型肺炎及自體免疫疾病後，由影像特徵初步診斷為隱源性器質性肺炎並開始靜脈注射類固醇治療。病患因近期置放心導管支架使用雙重抗血小板藥物，不建議支氣管鏡切片診斷，但對於類固醇治療良好且快速的反應，支持隱源性器質性肺炎診斷。後續因停止類固醇治療所發生的快速復發及重新使用類固醇治療後的再緩解，也恰好顯現隱源性器質性肺炎獨特的臨床表現。

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