长期应用复方薄荷脑滴鼻液导致外源性脂质性肺炎1例  

Exogenous lipoid pneumonia induced by long-term usage of compound menthol nasal drops:a case report

作　　者：路明[1] 闫葳 朱翔[2,3] 朱红[1] LU Ming;YAN Wei;ZHU Xiang;ZHU Hong(Department of Respiratory Medicine,Peking University Third Hospital,Beijing 100191,China;Department of Pathology,Peking University Third Hospital,Beijing 100191,China;Department of Pathology,Peking University School of Basic Medical Sciences,Beijing 100191,China)

机构地区：[1]北京大学第三医院呼吸科,北京100191 [2]北京大学第三医院病理科,北京100191 [3]北京大学基础医学院病理学系,北京100191

出　　处：《北京大学学报（医学版）》2019年第2期359-361,共3页Journal of Peking University:Health Sciences

摘　　要：外源性脂质性肺炎(exogenous lipoid pneumo- nia ,ELP)是由于脂类物质吸入后在肺内的异常沉积所发生的肺部少见疾病,临床表现不特异,容易被误诊为间质性肺炎和肺癌。从既往的临床经验和病例报道来看,该病多见于存在误吸高风险的人群,如精神异常、吞咽和胃肠功能障碍的老年人,其中以因肠梗阻、慢性便秘而使用液体石蜡作为通便药时发生误吸导致的外源性脂质性肺炎最为常见[1],其他情况所致者相对少见。本研究将北京大学第三医院2016年收治的1例长期应用油性滴鼻剂致外源性脂质性肺炎的诊治经过报道如下。Here we reported a case of exogenous lipoid pneumonia from Peking University Third Hospital. A 62-year-old male presented with chronic cough and expectoration for 8 years, without chest pain, hemoptysis or short of breath. He was an ex-smoker. In his past medical history, the patient reported chronic rhinitis sicca for 20 years. Chest computed tomography (CT) showed patchy ground glass opacities in his bilateral lower lobe. In recent 3 years, his symptoms showed slowly deteriorative changes, as did his chest CT findings. No improvement of the patient’s symptoms was observed, although he had been treated with many antibiotics. Then he was referred to our hospital for a detailed investigation for interstitial lung disease. On admission, the physical examination showed no abnormal findings except for inspiratory fine crackles in his bilateral lower lung field on auscultation. The results of the laboratory analysis , including complete blood cell count, biochemistry, arterial blood gas, urinalysis, antinuclear antibody (ANA), antineutrophil cytoplasmic antibody (ANCA) and tumor markers were all within normal ranges. To exclude the possibility of infectious or malignant conditions, bronchoscopy was performed. Secretions from the left lower lobe bronchus were collected for bacterial, fungal and fast-acid cultures, which were all negative. A bronchoalveolar lavage (BAL) was performed in the left lower lobe with a 30% recovery. The total cell count of the BAL fluid was 6.5×10 4/mL, and the cellularity diffe- rential revealed increased neutrophils(20%)and lymphocytes (17%). The cytological examination in the BAL fluid showed no malignant cells. All the clinical data above did not reveal any conclusive information. However, the pathological findings of his transbronchial lung biopsy (TBLB) were highlighted with lipid-laden macrophages engulfed by large vacuoles occupying almost completely the cytoplasm of the cells, which were consistent with those of exogenous lipoid pneumonia. Given these findings, it emerged that the

关 键 词：脂质性肺炎 外源性 油类 支气管镜检查 胸部CT 

分 类 号：R563.1[医药卫生—呼吸系统]