バイク修理工に発症した特発性肺胞蛋白症の1例 [in Japanese] A Case of Idiopathic Pulmonary Alveolar Proteinosis in a Motorcycle Mechanic [in Japanese]
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背景.本邦の特発性肺胞蛋白症では,23%に解体業・セメント工・地下鉄工事などの職業による粉塵吸入曝露歴の存在が報告されている.症例.64歳の男性.20歳からバイク修理業に従事し職場健診で胸部X線写真の異常を指摘された.胸部X線写真で両側下肺野に浸潤影を,胸部CT写真にて左下葉優位な斑状のすりガラス様陰影を両側性に認めた.気管支肺胞洗浄液中に光学顕微鏡でPAS染色陽性の好酸性物質を,電子顕微鏡でlamellar bodyを認め,抗granulocyte-macrophage colony-stimulating factor抗体高値より特発性肺胞蛋白症と診断された.結論.職業性吸入物質が特発性肺胞蛋白症発症にどのような影響を及ぼしているかについて,今後さらに症例を集積して詳細に検討することが必要である.
Background. Evidence of dust inhalation has been found to be present in 23% of patients with idiopathic pulmonary alveolar proteinosis (PAP) in Japan, particularly in those involved in occupations such as in building destruction, cement work and subway construction. Case. Abnormal shadows were detected on a chest radiograph during an annual medical screening a 64-year-old man who had worked as a motorcycle mechanic. Infiltrative shadows in bilateral lower lung fields were seen, and a chest CT scan showed bilateral patchy areas of ground-glass opacities, predominantly in the left lower lobe. Pathological examination under a light microscope revealed PAS-positive eosinophilic materials, and lamellar bodies were found in his bronchoalveolar lavage fluid by electron microscopy. Furthermore, a high titer of granulocyte-macrophage colony-stimulating factor indicated idiopathic PAP. Conclusion. In order to clarify the effects of occupational inhalation components on idiopathic PAP, more case reports are necessary.
- The Journal of the Japan Society for Respiratory Endoscopy
The Journal of the Japan Society for Respiratory Endoscopy 33(3), 182-186, 2011
The Japan Society for Respiratory Endoscopy