Successful Treatment with Corticosteroid in a Case of Elderly Severe Pulmonary Sarcoidosis Progressing to Acute Respiratory Failure

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  • Anai Satoshi
    Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University
  • Hamada Naoki
    Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University
  • Yanagihara Toyoshi
    Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University
  • Ogata-Suetsugu Saiko
    Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University
  • Yamamoto Norio
    Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University
  • Ogata Hiroaki
  • Ijichi Kayo
    Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University Division of Pathology, Kyushu University Hospital
  • Yoneshima Yasuto
    Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University
  • Harada Eiji
    Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University
  • Matsumoto Koichiro
    Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University
  • Nakanishi Yoichi
    Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University

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Other Title
  • 急速に呼吸不全が進行しステロイドが著効した高齢者の重症肺サルコイドーシスの1例
  • 症例報告 急速に呼吸不全が進行しステロイドが著効した高齢者の重症肺サルコイドーシスの1例
  • ショウレイ ホウコク キュウソク ニ コキュウ フゼン ガ シンコウ シ ステロイド ガ チョコウシタ コウレイシャ ノ ジュウショウ ハイ サルコイドーシス ノ 1レイ

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Abstract

<p>症例は81歳，女性．78歳時のぶどう膜炎診断時，両側肺門リンパ節腫大を指摘され，当科紹介受診．胸部CTで両肺上葉を中心とした浸潤影，両側肺門・縦隔リンパ節腫大，ACE上昇，気管支肺胞洗浄液中のリンパ球比率とCD4/CD8比の上昇，経気管支肺生検で非乾酪性類上皮細胞肉芽腫を認め，サルコイドーシスと診断．無治療経過観察中緩徐に肺病変の進行を認めていた．81歳時に週単位で増悪する呼吸不全の進行，下腿浮腫，体重増加を認め入院．BNP上昇，心陰影の拡大，肺浸潤影の著明な増悪を認め，心不全を疑い利尿薬の投与にて心拡大や浮腫は改善した．しかし肺浸潤影は改善せず，KL-6，ACEの著明な上昇も認め，肺病変の増悪と考え，全身ステロイドを投与したところ，肺浸潤影，酸素化は速やかに改善した．80歳以上の高齢者ではサルコイドーシスの臨床像は明らかでなく，様々な合併症もありステロイド導入の判断も難しいため報告する．</p>

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