サルコイドージスによる肺線維症に自然気胸を合併した1例

A case of pulmonary fibrosis due to sarcoidosis, complicated with spontaneous pneumothorax

　サルコイドージスは原因不明の全身性肉芽腫性疾患で特に肺・眼・皮膚・リンパ節に好発することが知られている。胸郭内病変としては胸部X線写真上，両側肺門リンパ節腫脹（bilateral hilar lymphadenopathy, BHL）と肺野の粒状・線状陰影が知られており，進行すると最後には肺線維症に至る。今回我々は，サルコイドージスによる高度の肺線維症に突然自然気胸を合併し，呼吸停止・心停止をきたしたが，救急蘇生により救命しえた1例を経験した。本邦におけるサルコイドージスの死亡原因としては心筋サルコイドージスに起因する不整脈死が最も多く報告されている^1）が，自然気胸の合併による呼吸停止・心停止の報告は調べえた限りでは見あたらず，文献的考察を加え報告する。

A 37-year-old woman had been suffered from sarcoidosis since 10 years ago and treated by pre-dnisolone in the other hospital. She had a syncopal episode followed by severe dyspnea. She was admitted to our hospital on ambulance immediately. On admission, she showed cardiac and respiratoryarrest. Emergent resuscitation was succeeded in rescue of her life. Chest X-ray examination revealed diffuse pulmonary fibrosis with right spontaneous pneumothorax and she underwent an operation. Histology of the lung was compatible with sarcoi-dosis. Then she was treated by prednisolone 60 mg every other day for sarcoidosis and shortness ofbreath decreased gradually.

It is known that pulmonary fibrosis due to sarcoi-dosis is frequently associated with bullous formation. But complication with pneumothorax is rare. It must be remembered that pneumothorax associated with sarcoidosis may be a possible cause of death.