A Case of Sarcoidosis Effective to Cyclophosphamide
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概要
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A 64 years-old man admitted because of acute respiratory failure (PaO2 39.6 Torr) with diffuse pulmonary interstitial shadows. Clinical diagnosis was interstitial pneumonia (unknown cause), but further examination cannot be done due to severe hypoxemia. So he was treated with steroid. Hypoxemia and diffuse interstitial shadows dramatically improved. After discharge prednisolone was tapered off, but 5 months later, uveitis occurred and pulmonary involvement exacerbated with mediastinal lymphadenopathy and increase of serum ACE level (19.4IU/l). Mediastinoscopic lymph node biopsy revealed non-caseating epithelioid cell granuloma. He received steroid therapy which improved uveitis and interstitial pneumonia. Although prednisolone was taperd, cataracta that is probably side effect by steroid therapy was exacerbated and serum ACE level increased again (24.3IU/l). So cyclophosphamide (50mg/day) was administrated with prednisolone, serum ACE decreased (5.4IU/l) and eye and lung involvement improved. For a severe case of sarcoidosis with interstitial pneumonia and uveitis, corticosteroid and cyclophosphamide therapy was effective.
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