1570 日胸 疾会 誌 30(8), Table 1 Laboratory findings on admission. CBC RBC 437X104/mma Hb 13.6g/dl Plts 7.4x104/m.3 WBC 8,300/mm St 18% Seg 3% Ly 68%
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1 Primary varicella pneumonia, Diffuse nodular pattern, Virus like particles
2 1570 日胸 疾会 誌 30(8), Table 1 Laboratory findings on admission. CBC RBC 437X104/mma Hb 13.6g/dl Plts 7.4x104/m.3 WBC 8,300/mm St 18% Seg 3% Ly 68% Aty-Ly 11 % ESR 5 mm/hr ABG ph pco2 PO mmHg 75.8 mmhg Serology CRP IgG IgA IgM IgE CH50 CD 4 CD 8 CD% 7.9mg/dl 800m&/cu 136mg/dl 64mg/dl 93 U/ml 47.5/ml 20.4% 37.4% 0.55 Biochemistry T.Bil 0.5mg/dl GOT 63 KU GPT 82 KU LOH 791 WU ALP 5. 5 KAU y-gtp 32 IU/1 Ch.E 0.79JpH BUN 15.4 mg/dl Cr 1. 1 mg/dl Na 140 meq/1 K 4.6 meq/1 Cl 106 meq/1 T.P 6.10g/dl Alb 63.0% a1-gl 6.0% a2-gl 11.5% /9-gl 8.1% y-gl 11.4% Urine Protein I-I Sugar (-) Feces occult blood (-) 2 Chest CT predominantly eral 1 Chest diffuse X-ray nodular on admission bilat- shadows. 3 Transbronchial infiltration (HE, diffuse nodular in the posterior lung of lymphocytes part shadows of the lungs. biopsy into interstitial space. x40) に散布 して認 め られ, そ の領域 の肺 野濃 度 も上 昇 して 経気 管 支的 肺生 検 を右B4, いた. 肺 組織 光顕 像( 3): 間 質 に単核 球 の浸潤 を認め 気管 支鏡 所 見で は気 管支 可視 範 囲内 に おい て は, 出 血, 浮 腫, 潰瘍 等 を認 め なか った. B8よ り施行 した. る もの の, 封 入体 は 明 らかで は なか った. 肺組 織 電顕 像: 1, II型上 皮細 胞 の萎縮, 肺 胞被 覆
3 原 発 性 水 痘 肺 炎 の1例 1571 細 胞 層 の破壊, 消失, 間 質 の線維 化, 浮 腫, 毛細 血 管 Acyclovir の壁 の肥厚 を認 め, 間質 を主 体 とす る ウ イルス肺 炎 の 中 和 抗 体 価 の 高 い γ グ ロ ブ リン を3日 病 理像 と矛盾 しない像 が 認 め られた( 4a). また広 熱 は 第2病 範 囲 に亘 って肺 の間質 系 を 中心 に再構 築 され て お り, 部X線 基 底膜 の発 達, 2次 性 ライ ソゾー ム様 構造 物 を容 れ る 形 成 さ れ な か っ た. 水 痘 ウ イ ル ス抗 体 価 は2週 巨細胞 構造, また ウイル ス粒子 様 構造 を もつ細 胞 もあ CF法 りウイル ス肺炎 を示唆 す る像 が認 め られ た( 41)). 臨床 経過(Table 5oOmg 750mgを1週 の 間 使 用 し た. 発 日 よ り解 熱 し水 痕 も痂 皮 化 し始 め, また 胸 写 真 上 結 節 影 は 徐 々 に 消 失 し石 灰 化 像 な ど も に て128倍, FA法 満, さ らにEIA法 2): 家 族歴, 皮 膚所 見, 炎 症反 応, 間, 更 にVZVへ に てIgGが320倍, に てIgGが1, 600倍, 間後 に IgMが10未 IgMが0. 80未 満 で あ っ た. そ の 後 順 調 に 経 過 し肺 機 能, 胸 部X線 抗 体価, 肺 野 で の多発 性 小結節 影 に よ り原 発性 水 痘肺 写 真 上 異 常 所 見 は 認 め ら れ な か っ た. 炎 と診 断 し,肺 炎 の悪 化 を防 ぐべ くCMZ 4g/日, TOB 120mg/日 の 抗 生 物 質 と と もに 抗 ウイ ル ス剤 と して 考 察 水 痘 ウ イ ル ス は 感 染 力 が 非 常 に 強 く, 多 くは 家 族 4a Electron of alveolar stitial micrograph lining layer, cells, and thickened fibrotic wall destruction change of inter- of capillary ves- 4b head) sels. (X5. 000) Table 2 Clinical Electron containing course of varicella (x15, micrograph virus-like 000) pneumonia. Vesicles CRP(n/at) VZ IgG (FA) IgM X320 <10 X320 <10 VZ(CF) X64 X128 VZV IgG (EIA) IgM (EIA) X1600 <0.80 particles. a giant cell (black arrow-
4 1) Krugman, S., Goodrich, C. H. & Ward, R.: Primary varicella pneumonia. N. Engl. J. Med., 257: 843, ) Weber, D. M. & Pellecchia, J. A.: Varicella pneumonia. Study of prevalence in adult men. J. A. M. A., 192: 228, 1965.
5 3) Billowa, J. G. M. & Wishik, S. M.: Complications of varicella, I; their occurrence among 2534 patients. Am. J. Dis. Child., 49: 923, ) Grose, C.: Variation on a theme by Fenner: The pathogenesis of chickenpox. Pediatrics, 68: 735, ) Asano, V., Itakura, N., Hiroshi, Y., Hirose, S., Nagai, T., Ozaki, T., Yazaki, T., Yamanishi, K. & Takahasi, M.: Viremia is present in incubation period in non-immunocompromized chidren with varicella. J. Pediatr., 106: 69, ) Triebwasser, J. H., Harris, R. E. & Bryant, RE.: Varicella paeumonia in adults Report of seven cases and a review of literature. Medicine, 46: 9) Starr, S. & Berkovich, S.: The depression of tuberculin reactivity during chickenpox. Pediatrics, 33: 769, ) Burnet, V. & White, DO.: Natural History of Infections Disease. 4th ed., Cambridge Univ. Press, London, 1972, a) p. 83. Abstract Case of Adult Primary Varicella Pneumonia Arata Uemura1), Akihiko Okano1), Masatoshi Iwata2) and Atsuhiko Satou2) 1) Division of Internal Medicine, Kakegawa General Hospital, 721 Sugiya, Kakegawa, Shizuoka Pref. 2) Second Department of Internal Medicine, Hamamatsu University School of Medicine, Handa-cho, Hamamatsu, Shizuoka Pref., Japan We report a case of adult primary varicella pneumonia. A 34-year-old man was admitted to our hospital with fever, dry cough and eruptions. He had no history of chicken pox and his sons had contracted varicella 2 weeks before the onset of his symptoms. Chest X-ray showed diffuse nodular shadows in both lungs. The diagnosis of primary varicella pneumonia was made based on family history, typical eruptions and high titer of antibody against Varicella zoster virus. An electron micrograph indicated this case to be primary varicella pneumonia with fibrosis and edema of interstitial spaces and the presence of virus-like particles in cells. The patient was treated with antibiotics, an antiviral agent and immunoglobulin. The clinical symptoms and diffuse nodular shadows resolved with this treatment.
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