Behcet 病に伴う器質化肺炎の一例

Abstract

症例は 61 歳男性．1995 年 37 歳時に口腔内アフタ，陰部潰瘍，ブドウ膜炎，結節性紅斑を認め完全型 Beh?et 病と診断され コルヒチン 1 mg/日と tocilizumab の治療を受けており，寛解状態で経過していた．2019 年 10 月 1 日に咳嗽，喀痰の増加を主 訴に近医を受診し，胸部 CT にて両側のびまん性多発粒状影を認めた．当初は細菌性肺炎が疑われ，抗生剤加療を行ったが不 応であったため，10 月 21 日に精査加療目的に当院へ転院となった．転院後に抗酸菌を含めた喀痰検査を行ったが起因菌は同 定されず，免疫学的検査でも異常を認めなかった．気管支鏡検査を行ったが，原因となる細菌は認められなかった．経気管支 肺生検で泡沫細胞の集簇とフィブリンの析出を認め，元々の完全型 Beh?et 病の既往もあり，Beh?et 病に関連した器質化肺炎 と診断し，ステロイド投与を開始したところ，呼吸状態，肺陰影ともに改善を認めた．Beh?et 病に器質化肺炎を合併する報告 は少なく , まれな病態と考えられる．

A 61-year-old man was diagnosed with complete Beh?et's disease with oral aphthae, genital ulcer, uveitis, and erythema nod osum at the age of 37 in 1995, and was treated with colchicine 1 mg / day and Tocilizumab in remission. On October 1, 2019, he visited a nearby doctor with a complaint of increased cough and sputum, and chest CT showed diffuse multiple granular shadows on lungs. Initially, bacterial pneumonia was suspected. He was treated with antibiotics but was unresponsive, so he was transferr ed to our hospital on October 21 for the purpose of detailed examination and treatment. After the transfer, a sputum test including acid-fast bacillus was performed, but the causative bacteria were not identified. Bronchoscopy did not reveal any abnormalities in immunological examination. Transbronchial lung biopsy showed aggregation of foam cells and precipitation of fibrin. Patients who were originally diagnosed with Behcet's disease were diagnosed with organized pneumonia associated with Behcet's disease, and when steroids were started, both respiratory status and lung shadows improved. There are reports of Behcet's disease associat ed with the organization of pneumonia. It is considered a rare condition.