每日一题_2023.09.21

A 54-year-old woman with asthma and allergic rhinitis presented with a 3-month history of productive cough and dyspnea. She also reported fevers, chills, night sweats, and an unintentional 9-kg (20-lb) weight loss. On lung examination, there was expiratory wheezing and diffuse crackles. Laboratory testing showed pronounced hypereosinophilia. A computed tomography of the chest showed upper lobe–predominant peripheral and subpleural consolidations that spared the perihilar region (shown). Serum testing for IgE against Aspergillus fumigatus, antibodies against coccidioides, and antineutrophil cytoplasmic antibodies was negative. Bronchoscopy with bronchoalveolar lavage was notable for 74% eosinophils in the cell count (reference value, <2) and negative tests for infectious diseases. What is the most likely diagnosis?

患者女，54岁，有哮喘和过敏性鼻炎，有咳痰和呼吸困难3个月病史。患者还自诉发热、寒战、盗汗和无意中体重减轻9 kg (20 lb)。肺部检查有呼气性喘息和弥漫性湿啰音。实验室检查示明显嗜酸性粒细胞增多。胸部计算机断层扫描显示上肺叶为主的周围和胸膜下实变，未波及肺门周围区域(如图所示)。抗烟曲霉IgE、抗球孢子菌抗体和抗中性粒细胞胞质抗体的血清检测结果为阴性。值得注意的是，支气管镜检查和支气管肺泡灌洗的细胞计数中有74%的嗜酸性粒细胞(参考值，<2)，并且感染性疾病的检测结果为阴性。最有可能的诊断是什么?

A. Allergic bronchopulmonary aspergillosis 变应性支气管肺曲霉菌病

B. Chronic eosinophilic pneumonia 慢性嗜酸粒细胞性肺炎

C. Cryptogenic organizing pneumonia 隐源性机化性肺炎

D. Drug-Induced eosinophilic pneumonia 药物性嗜酸性粒细胞性肺炎

E. Pulmonary tuberculosis 肺结核

答案解析：

诊断为慢性嗜酸性粒细胞性肺炎。这种疾病通常存在主要外周分布的气腔实变，以及外周嗜酸性粒细胞增多，而急性嗜酸性粒细胞性肺炎通常不存在外周嗜酸性粒细胞增多。开始口服泼尼松治疗。17天后随访时，患者症状减轻，影像学检查结果消失。患者继续服用泼尼松5个月，未再发作。

正确答案：B