グラム陰性菌や真菌の関与が示唆された加湿器肺の1例 A Case of
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1. 1 Banaszak EF Thiede WH Fink JN Hypersensitivity pneumonitis due to contamination of an air conditioner N Engl J Med 1970 283 271 276 Kane GC Marx JJ Prince DS Hypersensitivity pneu N monitis secondary to Alebsiella oxytoca A new cause of humidifier lung Chest 1993 104 627 629 3 Rylander R Haglind P Lundholm M et al Humidifier fe ver and endotoxin exposure Clin Allergy 1978 8 511 516 4 Rylander R Haglind P A2. Y REOR M TV hypersensitivity reacton toxic reaction 5715 16 De ae Ce BPR FE
3. Suda 1 6 38C Wk PaO 84 6 mmHg 64 5 mmHg VC 1 80 L 1 57 L Table 2 1
4. 2 B5a BAL 210 BAL PUR EX TBLB B3a A LAL 38 C IEDZ ORD FEAL GBD Ze X 2 g day K Figure 3a c 42 2011 31 1 TD 2 RAVE EL ORIIRE S 7M AED 1 RE RENO RABY Sol LROR BED Ha DEF MEVER CED O b NEDBABIBILA DNAD 7
5. 2011 31 41 46 A Case of Humidifier Lung Possible Contribution of Gram negative Bacteria and Fungi Shiro Imokawa Koji Nishimoto Seiichiro Suzuki Masahiro Uehara Masaki Ikeda Shinya Sagisaka Jun Sato Hiroshi Uchiyama Kazumasa Yasuda Yutaro Nakamura Takafumi Suda Kingo Chida Sh 58 0 OK OMERI OHE On KB ORE 35 7 8
6. K PAPA SE RP MLE AT OTE AWK KS PA MLE PK MEDRES 72 5 pg mL BAL TNFa IL 1 Th1 IL 8 51 alternative pathway
7. c Table 2 6h 8h 24h C 36 8 38 8 39 6 36 5 I Wk CRP mg dL 0 1 0 1 8 0 WBC uL 6 700 9 800 12 700 ABG room air PaO Torr 84 6 64 5 88 0 VC L 1 80 1 57 1 96 FEV L 157 1 10 161 44 2011 31 1 1 77ezzzo philic actinomycetes Klebsiella oxytoca ve Poy Pha YY Candida albicans Cephalosporium acremonium OFLA AEP CLM MOAI TS SBR Y EROS GHGAER 2 Candida albicans D Sphingomonas paucimobililis Bre vundimonas S ec7es
8. 3 12 1 2 T 438 8550 512 3 E mail fmrcw925 ybb ne jp 1 Department of Respiratory Medicine Iwata City Hospital 2 Department of Respiratory Medicine Hamamatsu University School of Medicine 2011 31 1 41 1 2 2 38 X
9. Ie At OAK OLE CT F ABHA CO b Brevun dimonas species Sphingomonas paucimobilis 8 D 64 5 pg mL 72 5 pg mL 4 D 8 6 pg mL 123 pg mL 13 3 pg mL 50 7 pg mL Ozxchterlony Candida albicans D A bas tE T 5 Aspergillus fumigates extract Alternaria kikuchiana extract Penicillium luteum extract Fusarium Extract Cladosporium extract Trichosporon asahii SL 2414 1 Table 1 RBC 397 x 10 uL CRP 2 5 mg dL ABG room air Hb 12 6 g dL IgG 1 552 mg dL pH 7 427 WBC 9 500 uL IgA 180 mg dL PaCO 32 9 Torr Neu 78 6 IgM 71 mg dL PaO 6
10. 37 2C 110 60 mmHg JR 88 24 WH WBC 9 500 uL CRP 25 mg dL KL 6 611 U mL SP D 373 ng mL PaO 69 0 Torr VC 70 9 DLco 65 2 Table 1 X Figure 1 CT Figure 2 Bo E
11. 9 0 Torr Ly 16 3 IgE RIST 46 IU mL Eos 0 6 C 147 mg dL Pulumonary function tests Na 138 mEq L Cy 36 mg dL VC 1 68 L K 4 6 mEq L CHo 69 0 U mL VC 70 9 CL 102 mEq L ANA lt x 40 FEV 1 45 L BUN 11 mg dL A DNA 2 0 FEV 77 0 Cr 0 54 mg dL RF 9 IU mL DLco 65 2 AST 19 IU L Clq lt 15 ug mL ALT 9 IU L PR3 ANCA lt 10 EU Bronchoalveolar lavage rtB LDH 212 IU L MPO ANCA lt 10 EU 58 0 CPK 53 IU L SS A lt 70 Total cell count 2 0 x 10 mL ALP 263 IU L SS B lt 70 Alveolar 753 TP 79 g dL ScL70 lt 70 macrophages ALB 44 g dL Jo 1 lt 70 Lymphocytes 21 0 KL 6 611 U mL Neutrophils 16 SP D 373 ng mL Eosinophils 1 0 BDYVAY lt 3084 pg mL CD4 CD8 2 24 Aid Figure 1 X Figure 2 CT 2011 31 1 43 1 a Figure 3 a b
12. TD NEVER ELD BI F 2n IB S M7 IMT AMO 1 vengas AS 1 EAER ee KMAR PRK 25 58 2 AW CT BAL B5a 21 0 VATS A Candida albicans DD 725 pg mL
13. irborne endotoxins and humidi fier disease Clin Allergy 1984 14 109 112 5 Muittari A Kuusisto P Sovijarvi A An epidemic of bath water fever endotoxin alveolitis Eur J Respir Dis 1982 63 suppl 123 108 116 6 Flaherty DK Deck FH Cooper J et al Bacterial endotox w in isolated from a water spray air humidification system as a putative agent of occupation related lung disease Infect Immun 1984 43 206 212 7 Ohnishi H Yokoyama A Hamada H et al Humidifier lung Possible contribution of endotoxin induced lung in jury Intern Med 2002 41 1179 1182 MAE 1 1997 35 1232 1237 Patterson R Fink JN Miles WB et al Hypersensitiv ee 9 ity lung disease presumptively due to Cephalosporium in homes contaminated by sewage flooding or by humidifier water J Allergy Clin Immunol 1981 68 128 132 2011 31 1 45 10 11 12 13 14 15 16 17 18 Suda T Sato A Ida M et al Hypersensitivity pneumo nitis associated with home ultrasonic humidifiers Chest 1995 107 711 717 Patterson R Mazur N Roberts M et al Hypersensitivity pneumonitis due to humidifier disease Seek and ye shall find Chest 1998 114 931 933 Ryan MP Adley CC Sphingom
14. onas paucimobilis a per sistent gram negative nosocomial infectious organism J Hosp Infect 2010 75 153 157 Gilligan PH Whittier S Burkholderia Stenotrophomonas Ralstonia Brevundimonas Comamonas and Acidovorax In Murray PR Baron EJ Pfaller MA et al Manual of clinical microbiology 7th ed American Society for Micro biology Washington 1999 526 538 Chi CY Fung CH Wong WW et al Brevundimonas Bac teremia Two case reports and literature review Scand J Infect Dis 2004 36 59 61 Thorn J The inflammatory response in humans after inhalation of bacterial endotoxin a review Inflamm Res 2001 50 254 261 Michel O Systemic and local airways inflammatory re sponse to endotoxin Toxicology 2000 152 25 30 Coleman A Colby TV Histologic diagnosis of extrinsic allergic alveolitis Am J Surg Pathol 1988 12 514 518 Katzenstein ALA Acute lung injury patterns diffuse alveolar damage and bronchiolitis obliterans organizing pneumonia In Katzenstein ALA ed Katzenstein and Askin1s surgical pathology of non neoplastic lung dis ease Saunders Philadelphia 2006 17 49 19 Suga M Yamasaki H Nakagawa K et al Mechanisms ac counting for granulomatous response in hypersensitivity pneumonitis Sarcoidosis Vasc Diffuse Lung Dis 1997 14 131 138 TD 2 RAVE VAP EL OBS ARB S 7M AED 1 46 Hz 2011 31 1
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