口服糖皮质激素治疗肺部浆细胞肉芽肿1例病例报告及文献复习

目的浆细胞性肉芽肿是炎性假瘤的一种亚型，是一种特发性的炎性假瘤，肺部多发，临床较为罕见，通过病例报告及文献复习提高对该病的认识。方法我们报道了1例39岁男性患者，以进行性胸闷、活动后气喘、活动耐量较平时减低为主要临床表现。胸部CT提示右肺多灶斑片影。给予充分抗感染治疗后复查胸部CT无明显变化，遂予CT引导经皮肺穿刺活检。HE染色显示肺泡间隔明显增厚及多量浆细胞及散在中性粒细胞侵润。肺间质局灶区胶原纤维增生和淋巴细胞聚集，未见明确上皮样肉芽肿，考虑浆细胞性肉芽肿。确诊后患者拒绝手术，随即给予口服糖皮质激素治疗。结果口服糖皮质激素治疗半年后，复查胸部CT提示肺部病灶得到吸收。结论对于临床多发斑片或者占位性病变，在抗感染治疗效果不佳后应积极通过活检取得病理帮助明确诊断，在活检病理提示炎症伴浆细胞浸润时要考虑浆细胞性肉芽肿疾病的可能性，并通过给予口服糖皮质激素取得满意疗效，避免误诊为吸收不佳的普通肺炎而延误治疗。

Oral corticosteroids for treatment of plasma cell granuloma of lung. a case report and literature review

Objective Plasma cell granuloma, a subtype of inflammatory pseudotumor, is an idiopathic inflammatory pseudotumor,most commonly found in lung. This artical aims to raise awareness of the rare disease through this case report and literature review. Methods A case of a 39-year-old young man was characterized with progressive chest tightness, dyspnea after exercise, and lower exercise tolerance. Chest CT showed multifocal patchy shadow in the right lung. When the chest CT result did not change significantly after anti-infective treatment, the patient was treated with percutaneous lung puncture biopsy guided by CT. HE staining showed that the alveolar septum thickened obviously,large quantities of plasmocytes and scattered neutrophils infiltration. Collagen fibers proliferated and lymphocyte accumulated in the focal area of pulmonary interstitium with no obvious epithelioid granulomas. The patient was diagnosed as plasma cell granuloma and refused operation. Results After six-month treatment with oral corticosteroid, the chest CT result showed the pulmonary lesion was absorbed. Conclusions Patients with chest CT manifestations of multiple plaques or ocupying should carry on the lung biopsy if the effect of anti-infective treatment is poor. If the biopsy result suggests inflammation with infiltration of plasma cells, we should consider the possibility of plasma cell granuloma. It can avoid to make misdiagnose as common pulmonary inflammation, senondly given oral glucocorticoid treatment can obtain satisfactory therapeutic effect.