一名41岁的女性患者在呼吸及重症医学科入院,北京大学第三医院因咳嗽一年。在她的CT扫描中可以看到多个胸膜下地面草和实性结节。入院前四个月,她开始经历口干眼干,视力模糊,手指关节疼痛,肌肉疼痛和下肢无力和体重减轻。在录取的时候,病人的生命体征正常,没有出现皮疹,两肺的呼吸音清晰,没有罗音或喘息,她手上没有畸形,没有发红,肿胀,或关节的压痛。双下肢无水肿。进行了一些实验室检查。肿瘤标志物包括鳞状细胞癌(SCC)抗原,神经元特异性烯醇化酶(NSE),癌胚抗原(CEA),Cyfra21-1,促胃泌素释放肽(proGRP),糖抗原125(CA125)和糖抗原199(CA199)均正常。抗核抗体,类风湿因子,抗中性粒细胞胞浆抗体,抗dsDNA抗体,抗Sm抗体,抗SSA/SSB抗体,抗核糖核蛋白(RNP)抗体,抗Jo-1抗体,抗SCL-70抗体和抗核糖体抗体均为阴性.血IgG水平正常。血液真菌β-1.3-D葡萄糖,曲霉半乳甘露聚糖抗原,痰细菌和真菌培养,痰涂片抗酸染色均为阴性。肺功能正常。支气管镜检查显示气道及黏膜正常。为了明确诊断,她做了胸腔镜肺活检,组织病理学提示滤泡性细支气管炎(FB)合并非特异性间质性肺炎(NSIP).她没有接受任何治疗,7个月后,肺部混浊自发消退。经过7年的随访,她的肺部混浊没有复发.为了提高对FB的理解,在万方以“滤泡性毛细支气管炎”为关键词进行了文献研究,PubMed和Ovid数据库。时间间隔为2000年1月至2018年12月。检索相关文献,分析FB的临床治疗和预后。文献综述包括18篇关于FB的完整记录的文章。共报告51例成人FB患者,包括18个主要FB和33个次要FB,自身免疫性疾病是最常见的根本原因。41例(80.4%)患者接受糖皮质激素和/或免疫抑制剂治疗,6例(11.8%)患者接受抗感染治疗,5例(9.8%)患者未接受任何治疗。最长随访时间为107个月。在没有任何治疗的5名患者中,1例患者死于转移性黑色素瘤,1例患者肺部混浊无变化,3例患者肺部混浊严重。总之,FB是一种罕见的疾病,治疗和预后存在争议。皮质类固醇和免疫抑制剂可能是有效的。该病例报告提示FB自发缓解的可能性。
A 41-year-old female patient was admitted in Department of Respiratory and Critical Care Medicine, Peking University Third Hospital because of having cough for a year. Multiple subpleural ground grass and solid nodules could be seen on her CT scan. Four months before admission, she began to experience dry mouth and eyes, blurred vision, finger joints pain, muscle pain and weakness in both lower limbs and weight loss. At the time of admission, the patient\'s vital signs were normal, no skin rash was seen, breath sounds in both lungs were clear, no rales or wheeze, no deformities in her hands, no redness, swelling, or tenderness in the joints. There was no edema in both lower limbs. Some lab examinations were performed. Tumor markers including squamous cell carcinoma (SCC) antigen, neuron-specific enolase (NSE), carcinoembryonic antigen (CEA), Cyfra21-1, pro-gastrin-releasing peptide (proGRP), carbohydrate antigen 125 (CA125) and carbohydrate antigen 199 (CA199) were all normal. The antinuclear antibody, rheumatoid factor, antineutrophil cytoplasmic antibody, anti-dsDNA antibody, anti-Sm antibody, anti-SSA/SSB antibody, anti-ribonucleoprotein (RNP) antibody, anti-Jo-1 antibody, anti-SCL-70 antibody and anti-ribosomal antibody were all negative. The blood IgG level was normal. The blood fungal β-1.3-D glucose, aspergillus galactomannan antigen, sputum bacterial and fungal culture, and sputum smear test for acid-fast staining were all negative. Lung function was normal. Bronchoscopy showed the airways and mucosa were normal. To clarify the diagnosis, she underwent thoracoscopic lung biopsy, the histopathology revealed follicular bronchiolitis (FB) with nonspecific interstitial pneumonia (NSIP). She did not receive any treatment and after 7 months, the lung opacities were spontaneously resolved. After 7 years of follow-up, the opacities in her lung did not relapse. To improve the understanding of FB, a literature research was performed with \"follicular bronchiolitis\" as the key word in Wanfang, PubMed and Ovid Database. The time interval was from January 2000 to December 2018. Relative articles were retrieved and clinical treatments and prognosis of FB were analyzed. Eighteen articles concerning FB with complete records were included in the literature
review. A total of 51 adult patients with FB were reported, including 18 primary FB and 33 secondary FB, and autoimmune disease was the most common underlying cause. Forty-one (80.4%) patients were prescribed with corticosteroids and/or immunosuppressive agents, 6 (11.8%) patients were treated with anti-infective, 5 (9.8%) patients did not receive any treatment. The longest follow-up period was 107 months. Among the 5 patients without any treatment, 1 patients died of metastatic melanoma, the lung opacities were unchanged in 1 patient and getting severe in 3 patients. In conclusion, FB is a rare disease, the treatment and prognosis are controversial. Corticosteroid and immunosuppressive agents could be effective. This case report suggests the possibility of spontaneous remission of FB.