副鼻腔気管支症候群を合併したGood症候群の一例

Abstract

症例は64歳男性．肺炎精査のために撮像された胸部CTで縦隔腫瘍を指摘され，胸腔鏡下縦隔腫瘍摘出術で胸腺腫 （ AB型，正岡分類Ⅰ期） と診断された．その後，難治性の副鼻腔炎で手術加療を要し，再度肺炎を発症したため当科を受診された．低γグロブリン血症を認め，胸部CTでは両肺全域に小葉中心性粒状影や気管支拡張像を認めたため，Good症候群に伴う副鼻腔気管支症候群 （ Sinobronchial syndrome：SBS）と診断し，長期少量マクロライド療法とγグロブリン補充療法で良好な経過を得た．

A 64‐year‐old man complained of fever and cough．We diagnosed him with bacterial pneumonia because his chest computed tomography (CT) showed an infiltrate shadow．However，a mediastinal tumor was also found incidently in the chest CT at that time．After treating the pneumonia，we performed a thoracoscopic mediastinal tumorectomy and diagnosed the tumor as a type AB thymoma．After this surgery，he needed surgical treatment for refractory sinusitis， and suffered from pneumonia two times．Blood tests showed hypogammaglobulinemia and Chest CT showed small nodules in centrilobular lesions and bronchodilation in all lung fields．Chronic sinusitis，repeated pneumonia and immunodeficiency led to a diagnosis of sinobronchial syndrome caused by Good’s syndrome．We treated him with an immunoglobulin supplement and low-dose-long-term macrolide antibiotic．After these treatments，he has been free of infections for several years.