临床误诊误治2025，Vol.38Issue(19)：7-11,5.DOI:10.3969/j.issn.1002-3429.2025.19.002
过敏性肺炎误诊分析及经验分享
Analysis and experience sharing of misdiagnosis of hypersensitivity pneumonia
摘要
Abstract
Objective To investigate the clinical characteristics and causes of misdiagnosis of hypersensitivity pneumonia(HP).Methods The clinical data of 8 patients who had been misdiagnosed with HP and were admitted from February 2022 to May 2024 were retrospectively analyzed.Results Among the 8 patients,4 had a history of eating Marine fish,1 had a history of eating silkworm pupae,and 1 had a history of contact with pigeons.The remaining patients had an unknown history of allergy,and all denied a history of travel to epidemic areas or exposure to special medications.Six patients had cough,fever,chills,dyspnea,and chest X-ray examination showed multiple diffuse micro-nodules in both lungs and ground glass exudation in both lower lungs.Eosinophil count,as well as blood white blood cells,procalcitonin and C-reactive protein,was not high,and tumor markers were normal.They were initially diagnosed as viral pneumonia,and antiviral treatment was not effective,therefore,consultation was requested.Combined with clinical manifestations,further inquiry about allergy history,and additional examinations including chest CT,pulmonary function test and bronchoalveolar lavage fluid(BALF)test,the patient was diagnosed with HP.Two patients were diagnosed with recurrence of pulmonary tuberculosis because of fever,cough,weight loss,fatigue,imaging examination that showed thickened and fibrotic changes in the middle and upper lobules of both lungs,and a history of pulmonary tuberculosis.Regular anti-tuberculosis treatment for 1 month did not show any effect,and then HP was confirmed through pathological examination following lung biopsy The misdiagnosis duration of 8 patients ranged from 1 week to 2 months.After diagnosis,6 patients were treated with glucocorticoid combined with traditional Chinese medicine decoction,and 2 patients were treated with desensitization.After 2 months of follow-up,7 patients were cured,and 1 patient experienced a recurrence and had symptoms resolved after re-application of glucocorticoids.Conclusion The clinical and imaging manifestations of HP are diverse and non-specific,and it is prone to misdiagnosis and missed diagnosis.Clinicians should strengthen the understanding of HP,inquire about the medical history and contact history in detail,and be vigilant.If necessary,BALF and lung biopsy should be performed to confirm the diagnosis.关键词
过敏性肺炎/误诊/病毒性肺炎/肺结核/鉴别诊断/支气管肺泡灌洗液Key words
hypersensitivity pneumonia/misdiagnosis/viral pneumonia/tuberculosis/differential diagnosis/bronchoalveolar lavage fluid引用本文复制引用
李惠惠,黄桂琼,陈洪..过敏性肺炎误诊分析及经验分享[J].临床误诊误治,2025,38(19):7-11,5.基金项目
广东省中医药局科研项目(20241328) （20241328）
