A Case of Highly Suspected Hypersensitivity Pneumonia Presenting Pathologically as Organizing Pneumonia Pattern Hiroyuki Yamanaka 1 , Daisuke Taniyama 2 , Keisuke Miyamoto 2 , Ako Takada 2 , Fumio Sakamaki 2 1Department of Medicine, Tokyo Saiseikai Central Hospital 2Department of Respiratory Medicine, Tokyo Saiseikai Central Hospital Keyword: 過敏性肺炎 , 器質化肺炎 , 胸腔鏡下肺生検 , hypersensitivity pneumonia , organizing pneumonia , thoracoscopic surgical lung biopsy pp.631-635
Published Date 2011/6/15
DOI https://doi.org/10.11477/mf.1404101725
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 A 67-year-old man, who lived in an apartment room for more than 20 years and regularly used the humidifier and private bath keeping hot water for one day, was admitted to our hospital because of fever, cough and dyspnea. Chest X-ray and CT on admission revealed diffuse infiltration of the bilateral upper lung fields. His symptoms and infiltrative shadows on chest X-ray were quickly improved by the administration of antibiotics, and he was discharged from hospital 8 days after admission. One day after discharge, fever and dyspnea recurred, and he was re-admitted to hospital. Chest X-ray and CT demonstrated diffuse ground glass infiltration of the bilateral lung fields, which quickly improved after re-admission. After a trial of home-stay for several days, body temperature, white blood cell count and serum C-reactive protein level were elevated again. We suspected hypersensitivity pneumonea(HP), and surgical lung biopsy with thoracoscopy was performed. The pathological specimen showed organizing pneumonia, but no typical nonnecrotizing granulomas. Administration of corticosteroid was started and his symptoms and radiologic findings were improved. He was discharged after drastic modification of his home, and his suspected HP has not recurred, in spite of tapering and stopping the corticosteroid. This case was highly suspected to be acute hypersensitivity pneumonia. However, the histopathological examination demonstrated organizing pneumonia pattern without typical granulomas.

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