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題 名 | Difficulty in Diagnosing Churg-Strauss Syndrome--A Case Report=困難診斷的Churg-Strauss症候群--病例報告 |
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作 者 | 王瑞鍾; 陳中和; 黃世鴻; 徐志育; | 書刊名 | 胸腔醫學 |
卷 期 | 26:1 2011.02[民100.02] |
頁 次 | 頁19-26 |
分類號 | 415.74 |
關鍵詞 | Churg-Strauss症候群; 嗜伊紅性球增多肋膜積液; 延遲診斷; Churg-Strauss syndrome; Hyper-eosinophilic pleural effusion; Delayed diagnosis; |
語 文 | 英文(English) |
中文摘要 | Churg-Strauss症候群是一種罕見的小血管性血管炎,它能侵犯身體的各個器官。如果沒有給予治療,這個疾病幾乎總是致命的。但是診斷常常被延遲,而這會導致某些器官的永久損傷。我們報告一個37歲男性,因為咳嗽有痰、發燒,漸進性呼吸困難而住院治療。他曾經有輕度氣喘、嗜伊紅性血球增多症,亞急性心臟瓣膜炎。胸部X光顯示有肺內病灶及左側肋膜積液。起初,他被診斷為肺炎倂有肺炎旁肋膜積液,經過10天的住院治療,卻發生急性心因性水腫。然而,嗜伊紅性球增多肋膜積液於細胞學抹片檢查時被證實。我們高度懷疑是Churg-Strauss症候群併有嗜伊紅性球增多肋膜積液,並且侵犯到心臟而致病。幸運地,在使用類固醇脈衝治療後,心因性肺水腫獲得緩解。使用類固醇脈衝治療的十七天之後,心臟內膜切片顯示在心肌組織內仍然有嗜伊紅性球浸潤其中。從這個複雜的病例中我們知道,嗜伊紅性球增多肋膜積液如果被判讀成嗜中性球增多,這會導致一個診斷上的延遲。臨床醫師應該要能警覺地去比較人工讀片和機器讀片的差異性。 |
英文摘要 | Churg-Strauss Syndrome (CSS) is a very rare form of small vessel vasculitis which could affect any organ system. Untreated, the disease is almost always fatal. Diagnosis is often delayed, which can result in permanent organ damage. We report a 37-year-old man with cough with sputum, fever, progressive dyspnea. He had a history of mild persistent bronchial asthma, eosinophilia and subacute infective endocarditis. Chest X-ray showed pulmonary opacities and left pleural effusion. He was initially diagnosed with and treated for pneumonia with parapneumonic effusion, but acute cardiogenic pulmonary edema developed 10 days after admission. However, eosinophilic pleural effusion was subsequently demonstrated by cytological examination. CSS with eosinophilic effusion and cardiac involvement was highly suspected. Fortunately, the cardiogenic pulmonary edema resolved after steroid pulse therapy. Endomyocardial biopsy revealed subendocardial infiltration of eosinophils even 17 days after pulse therapy with methylprednisolone. In this complicated patient, the hyper-eosinophilic pleural effusion was recognized as being composed predominantly of polymorphonuclear neutrophils (PMNs), which may have lead to a delayed diagnosis. The physician should be aware of the importance of cytological study, as compared with automated hemocytometric analysis. |
本系統中英文摘要資訊取自各篇刊載內容。