慢性関節リウマチに合併したリンパ球性間質性肺炎の1例

Lymphoid Interstitial Pneumonia Associated with Rheumatoid Arthritis

　症例は61歳，女性．7年前に慢性関節リウマチを発症．1998年7月より乾性咳嗽，微熱，右背部痛が出現した．胸部X線写真，CTで右上下葉に胸膜側に変化の強い浸潤影を認めた．各種抗生剤投与にもかかわらず，高熱および呼吸困難が出現した．胸腔鏡下肺生検を施行し，リンパ球性間質性肺炎と診断した．シェーグレン症候群の合併はなかった．ステロイドパルス療法0.5g／日を3日間，引き続きプレドニゾロン50mg／日で治療を行い，症状および胸部X線所見は改善した．RA患者にみられる肺病変の一つとしてLIPを念頭に入れておく必要がある．

A 61-year-old woman with a 7-year history ofrheumatoid arthritis was admitted to the hospital. Shenoticed dry coughing, low-grade fever and right backpain that had begun in July, 1998. Chest X-ray film andCT scan showed peripheral infiltrative shadows in theright upper and lower lobe. In spite of treatment withvarious antibiotics, she had developed high fever andprogressive dyspnea. Examination of a specimenobtained by thoracoscopic biopsy showed lymhoid inter-stitial pneumonia. Sjögren syndrome was not diagnosed.She was treated with 0.5g of methylprednisolone dailyfor 3 days, followed by 50mg of prednisolone daily. Hercondition improved dramatically, and chest X-rayfindings improved. LIP should be taken into account asa potential complication of RA associated lung disease.