移動性の浸潤影を呈した Bronchiolitis Obliterans Organizing Pneumonia (BOOP) と考えられる 1 例 A Case of Wandering Shadow Diagnosed as Bronchiolitis Obliterans Organizing Pneumonia

症例は55歳, 男性。昭和62年10月の検診で胸部異常影を指摘され当科受診。左肺野に広範囲の浸潤影を認めたが, 経過中, 左肺野の陰影は自然消退し, 新たに右上肺野に浸潤影が出現した。血中, BAL中に好酸球増多が認められなかったため, BOOPを考えTBLBを施行した。採取した肺組織では, 器質化肺炎を伴った胞隔炎が認められた。肉芽組織による細気管支の閉塞像は認められなかったが, 臨床像を踏まえ, BOOPと診断した。右肺の浸潤影も軽快傾向が認められたため, 本例は無治療で経過観察し, 本年2月には陰影はほぼ消失した。

A 55-year-old male was introduced to our clinic in October 1987 because of an abnormal shadow in the left lung field. The infiltrate disappeared spontaneously and an another infiltrate appeared in his right upper lung field during the observation period. Since no eosinophilia was noted in the peripheral blood or bronchoalveolar lavage fluid, bronchiolitis obliterans organizing pneumonia (BOOP) was suspected and transbronchial lung biopsy (TBLB) was performed for confirmation. The pathologic finding was alveolitis with organizing pneumonia. We were unable to detect any obstructive findings in the bronchioli, since few bronchioli were obtained by TBLB. However, we diagnosed this case as BOOP on the basis of the clinical pictures. The infiltrate in the right lung showed a tendency to improve spontaneously and no therapy was performed. The shadow had disappeared almost completely by February 1988.