电焊工肺反复发热伴肺多发结节  

Multiple pulmonary nodules in an electric welder with recurrent fever

作　　者：汪劭婷 冯瑞娥[2] 陈苗[3] 田欣伦 施举红[1] 宋兰[4] 杨燕丽 Wang Shaoting;Feng Rui'e;Chen Miao;Tian Xinlun;Shi Juhong;Song Lan;Yang Yanli(Department of Pulmonary and Critical Care Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100730,China;Department of Pathology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100730,China;Department of Hematology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100730,China;Department of Radiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院呼吸与危重症医学科,北京100730 [2]中国医学科学院北京协和医院病理科,北京100730 [3]中国医学科学院北京协和医院血液内科,北京100730 [4]中国医学科学院北京协和医院放射科,北京100730

出　　处：《中华结核和呼吸杂志》2025年第4期373-377,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：中央高水平医院临床科研专项(2022-PUMCH-B-107)。

摘　　要：本文报道1例骨髓增生异常综合征(MDS)男性患者,为33岁电焊工,临床以反复发热起病,实验室检查提示贫血、血小板计数减低、炎症指标升高,并有血培养阳性,胸部影像学有双肺弥漫性粟粒样结节、纵隔肿大淋巴结及反复新发斑片影。抗细菌治疗不佳。后行经肺活检病理诊断为肺铁尘沉积、胆固醇肺炎、肺泡蛋白沉积症(PAP),继发曲霉感染,患者经抗真菌、短期抗细菌治疗后体温恢复正常。综合考虑患者病情可能为MDS继发PAP、胆固醇肺炎,MDS致白细胞功能降低引发后续的肺曲霉及血源性感染。本病例强调了在有复杂肺部表现的患者中,考虑潜在血液系统疾病的重要性。同时,本病例也为MDS与PAP之间关系的有限真实世界数据提供了补充,尤其是针对存在职业暴露和并发感染的患者。This article reported a 33-year-old male electric welder with myelodysplastic syndrome(MDS)who presented with recurrent fever.Laboratory tests revealed anemia,thrombocytopenia,elevated inflammatory markers,and positive blood cultures.Chest imaging examinations showed diffuse miliary nodules in both lungs,enlarged mediastinal lymph nodes,and recurrent new patchy shadows in the lungs.Antibacterial treatment was ineffective.Through video-assisted thoracoscopic surgery and pathology,the patient was diagnosed with pulmonary iron dust deposition,lipoid pneumonia,pulmonary alveolar proteinosis(PAP)and secondary aspergillus infection.After antifungal and short-term antibacterial treatment,the patient′s body temperature returned to normal.Considering the patient′s overall condition,it is likely that MDS led to secondary PAP and lipoid pneumonia,and the decreased white blood cell function caused by MDS triggered subsequent pulmonary aspergillosis and bloodstream infections.This case highlighted the importance of considering potential hematological diseases in patients with complex pulmonary manifestations.At the same time,this case added to the limited real-world data on the relationship between MDS and PAP,particularly in patients with occupational exposures and concurrent infections.

关 键 词：骨髓增生异常综合征 曲霉菌病 肺泡蛋白沉积症 

分 类 号：R563.1[医药卫生—呼吸系统] R563[医药卫生—内科学]