Bronchiolitis Obliterans Organizing Pneumonia as the First Manifestation of Polymyositis

다발성근염의 선행증상으로 나타난 폐쇄성 세기관지염 기질화 폐렴

Bronchiolitis obliterans organizing pneumonia (BOOP) preceding polymyositis is rare. In this report, a 40-year-old patient with fever, chillness, generalized myalgia and progressive exertional dyspnea, had bilateral interstitial infiltrates on chest radiograph. High-Resolution CT showed subpleural and peribronchial distribution of airspace consolidation. Open lung biopsy was consistent with BOOP. Prednisolone therapy led to improvement, but during tapering of prednisolone for 3 months to 30 mg, he complained of weakness of both lower legs. One month later, prednisolone was tapered to 15 mg a day, fever. chillness and generalized myalgia were recurred. He complained of weakness of both arms. The creatine kinase (CK) with MM isoenzyme, lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) were elevated. Anti-Jo1 antibody was positive. Vastus lateralis muscle biopsy was compatible with polymyositis. After injection of methylprednisolone for 1 week, the patient became afebrile, the dyspnea resolved, the pulmonary infiltrates decreased, and the muscle strength improved. The serum CK, LDH, AST levels declined significantly. Patients with idiopathic BOOP should have follow-up for the possible development of connective tissue disorders including polymyositis.

저자들은 40세 남자환자에서 고열과 호흡곤란, 기침을 주소로 내원하여 개흉 폐생검상 폐쇄성 세기관지염 기질화 폐렴 진단 후 스테로이드 치료로 호전을 보이다가 임상증상의 재발과 함께 다발성근염을 보인 후 재차 스테로이드 치료에 반응을 보인 1예를 경험하였기에 이를 보고하는 바이다.