儿童过敏性肺炎1例并文献复习

目的 总结儿童过敏性肺炎的临床、影像学和病理学特点。方法 对病理确诊的1例9岁6个月的过敏性肺炎患儿的临床、影像学和病理学资料进行总结，并复习文献进行讨论。结果 以咳嗽4个月、气促为主要表现，无咳痰、无三凹征，肺内未闻及啰音，无杵状指趾。肺功能示混合性通气功能障碍。肺部高分辨CT表现为弥漫的细小结节影，以上肺为重，肺组织病理为细支气管炎、细支气管周围的间质淋巴细胞炎症和间质的多核巨细胞，无纤维化和结核结节，可见大量的泡沫细胞。脱离环境并予甲泼尼龙2 mg·kg-1·d-1治疗2周后，患儿咳嗽、气促症状有所减轻,肺功能有所改善，肺部CT的小结节影明显改善。糖皮质激素治疗2个月后呼吸道症状消失，肺部影像学和肺功能恢复正常。结论 过敏性肺炎为无特异的沉淀抗体的病例，主要依靠肺活检病理细支气管炎、细支气管周围间质炎症和找到非干酪的不典型肉芽肿或多核巨细胞确定诊断。亚急性过敏性肺炎用糖皮质激素治疗有效。

Hypersensitivity pneumonitis in children: one case report and literature review

Objective To understand the clinical and pathologic features of the hypersensitivity pneumonitis in children. Methods A case of nine years and six months old girl with hypersensitivity pneumonitis admitted to Beijing Children′Hospital in the April of 2012 was reviewed. Results The symptoms were cough for 4 months, short breath, no sputum and fevers, no dyspnean or digital clubbing. The diffused micronodules were found in the high-resolution CT of the bilateral lung. The cellular bronchiolitis and bronchiolocentric lymphocytic pneumonitis were presented in the pathology of the lung , the abundant foamy cells in the interstitium and giant cells in the interstitial spaces also were found in the pathology. No evidence of the tuberclusis and virus infection and connective tissue disease was found. The symptoms and abnormal of the HRCT findings were improved after 26 days avoidance of the environment exposure, and were improved evidently after two-week treatment of the corticosteroid. The patient was recovered almost completely after two months of the treatment. Conclusions The manifestation of the subacute hypersensitivity pneumonitis in the HRCT is diffused micronodules. Subacute hypersensitivity pneumonitis in children is well reponsible to the treatment of corticosteroid. Histological diagnosis of the hypersensitivity pneumonitis is predicated on the recognition of the poor formed granulomatous or giant cells in the interstitial spaces.