パラインフルエンザ1型の抗体価の上昇を伴い特異な胸部X線所見を呈した器質化肺炎の1例

Abstract

A case of organizing pneumonia is reported. A 74-year-old man was admitted to our hospital complaining of general fatigue and dyspnea of 2 months' duration. Chest roentogenogram on admission revealed interstitial shadow in the left upper-to-middle lung field. Thereafter the chest x-ray shadow showed migration to the left lower lung and right middle lung fields, and superimposition with volume loss of the left lower lung. No pathogenic microorganisms were detected from sputum and throat swabs. No organisms were detected in the blood. Therefore he was set to conservative therapy alone. The antibody titer of parainfluenza virus type 1, initially 1:64, increased to 1:2048 just before bronchoscopy. The histopathological findings of TBLB showed that alveolar spaces were filled with organizing process and that septum was thickened slightly with edema and fibrosis, whose findings were compatible for organizing pneumonia. Prednisolone was begun and marked improvement of chest x-ray findings and clinical symptoms were achieved immediately. But recurrence was seen twice during withdrawal of steroids within six months and he died suddenly of unknown cause. Autopsy could not be performed. Although the pathogenesis of organizing pneumonia has not been determined yet, this case was of interest in two points : first, the chest x-ray finding was thought to be interstitial rather than alveolar process ; and second, antibody of parainfluenza virus type 1 fluctuated, suggesting some pathogenetic relation.