以急性纤维素性机化性肺炎为初始表现的类风湿关节炎1例并文献复习

本院收治确诊的类风湿关节炎（RA）相关急性纤维素性机化性肺炎（acute fibrinous and organizing pneumonia, AFOP）1例,主要表现为发热、低氧血症、呼吸困难,体格检查双肺少许干湿性罗音,胸部CT表现为双肺实变,少许胸腔积液,类风湿因子、抗CCP抗体显著升高,CT引导肺组织穿刺病理可见“纤维球”,诊断为RA相关AFOP,经激素治疗后病灶吸收好转。AFOP临床少见,病死率高,极易误诊重症肺炎,肺组织病理是确诊该病的金标准,激素是该病主要的治疗方案,尽早明确诊断是预后的关键。

Rheumatoid arthritis with acute fibrinous and organizing pneumonia as initial manifestation literature--a case report with review

One case of rheumatoid arthritis (RA) with acute fibrinous and organizing pneumonia (AFOP) was admitted. The clinical manifestations of this patient were mainly fever, hypoxemia, dyspnea, some dry and wet rales in the lungs, chest CT manifestation for lung consolidation and a little pleural effusion. The rheumatoid factors and anti CCP antibody greatly increased. “Fiber ball” was seen by CT guided pulmonary biopsy. The patient was diagnosed as RA related AFOP. And lesions absorption improved after the hormone therapy. AFOP, a rare clinical disease with high mortality, is easy to be diagnosed as severe pneumonia. Lung pathology is the gold standard for the diagnosis of AFOP, hormone is the main therapeutic schedule for the disease, and early confirmed diagnosis is the key to prognosis.