一名46岁的男性接受皮质类固醇治疗非特异性间质性肺炎(NSIP)。他被转诊到我们医院,并在皮质类固醇治疗期间因呼吸困难和胸部计算机断层扫描(CT)上弥漫性毛玻璃混浊而入院。Gottron\'ssign被观察到,患者在皮肤活检中被诊断为临床上的无肌病性皮肌炎。我们增加了皮质类固醇剂量并添加了免疫抑制剂;然而,胸部CT上的混浊加重。基于支气管肺泡灌洗液中的高碘酸希夫阳性颗粒物质和抗GM-CSF抗体的存在,患者被诊断为自身免疫性肺泡蛋白沉积症(APAP).当患者被诊断患有NSIP时,保存的血清中抗GM-CSF抗体的浓度也升高。因此,我们假设NSIP和APAP共存,APAP在免疫抑制治疗期间表现出来。当在用免疫抑制剂治疗间质性肺炎期间观察到恶化时,有必要考虑APAP。
A 46-year-old male was treated with corticosteroids for nonspecific interstitial pneumonia (NSIP). He was referred to our hospital and admitted for worsening dyspnea and diffuse ground-glass opacity on chest computed tomography (CT) during corticosteroid treatment. Gottron\'s sign was observed, and the patient was diagnosed with clinically amyopathic dermatomyositis on skin biopsy. We increased the corticosteroid dose and added immunosuppressive agents; however, the opacity on the chest CT worsened. Based on periodic-acid-Schiff-positive granular material in the bronchoalveolar lavage fluid and the presence of anti-GM-CSF antibodies, the patient was diagnosed with autoimmune pulmonary alveolar proteinosis (APAP). The concentration of anti-GM-CSF antibodies in preserved serum was also elevated when the patient was diagnosed with NSIP. Thus, we assumed that NSIP and APAP coexisted, and that APAP manifested during immunosuppressive therapy. When exacerbation is observed during the treatment of interstitial pneumonia with immunosuppressive agents, it is necessary to consider APAP.