ARDSを呈しステロイドパルス療法により軽快したオウム病の1例

A case of psittacosis presenting as adult respiratory distress syndrome and successfully treated with steroid pulse therapy

　オウム病はChlamydia psittaciによる感染症であり，軽症から重篤な肺炎まで幅広い臨床像を示すとされている^1）。著者らは成人呼吸窮迫症候群（ARDS）を呈し，ステロイドパルス療法および器械呼吸にて治癒しえたオウム病の1例を経験したので報告する。

The patient is a 47 year old woman who suffered from fever and dry cough. On examination, she was very ill and her temperature was 38.6℃, respira-tory rate 32/minute. Chest X-ray films disclosed wi-despread bilateral pneumonia without cardiomegaly. Breathing air arterial oxygen tension (PaO₂) was 40 mmHg and carhon dioxide tension (PaCO₂) 32 mmHg. Bacterial culture from her sputum, blood, and urine were negative. Next day after admis-sion, the patient was diagnosed as adult respiratory distress syndrome (ARDS), and pulse therapy with methylprednisolone in a dosage of 500 mg per day for three days, in combination with minocycline 100 mg 12-hourly and γ-globulin was started. How-ever, PaO₂ remained low so that mechanical ventila-tion with 100 mmH₂O was applied. Thereafter she recovered sufficiently to stop mechanical ventilation after 4 days. 17 days after admission the diagnosis of psittacosis was made on a 64-fold rise in comple-ment-fixation test titre and further questioningrevealed that her family was keeping hundreds of parrots and budgerigars, from which it is thougt she contacted the disease.

It is conceivable that steroid pulse therapy was greatly useful for the present case of psittacosis pre-senting as ARDS.