Blepharoptosis Due to Sarcoidosis-Induced Horner Syndrome
Blepharoptosis Due to Sarcoidosis-Induced Horner Syndrome
复制标题
结节病诱发的霍纳综合征引起的上睑下垂
DOI：
10.1164/rccm.201807-1285im
复制
发表时间：
2019
影响因子：
24.7
通讯作者：
Nakayama Katsutoshi
中科院分区：
文献类型：
--
作者：
Takeda Masahide;Sato Kazuhiro;Sano Masaaki;Sakamoto Sho;Izumiya Yuka;Kumagai Naho;Sudo Kazuhisa;Asano Mariko;Okuda Yuji;Nakayama Katsutoshi
一位39岁的女性因为X光片显示右肺有结节状阴影而住进我院。10年前，她被临床诊断为眼部和肺部结节病，但目前没有服用任何药物。入院时，她出现双侧上睑下垂伴瞳孔缩小（图1A）。我们进行了支气管镜检查，并作出了诊断肺结节病的基础上，组织学检查。乙酰胆碱受体抗体、肌张力和眼球运动检查均无异常。由于脑部磁共振成像也未能显示任何异常，我们进行了颈部计算机断层扫描（CT），显示双侧锁骨上淋巴结肿胀（图2A，箭头）。然后，我们进行了正电子发射断层扫描（PET）-CT，以调查淋巴结病是否是由于结节病，因为PET-CT已被发现经常代表结节病活动性肉芽肿病变区域的阳性活动（1）。PET-CT显示锁骨上淋巴结积液程度与活检肺部病变相同。因此，我们认为双侧上睑下垂是由Horner综合征引起的。患者按照文献（1-3）中的建议接受皮质类固醇治疗（0.5 mg/kg/d），随后双侧眼睑下垂得到改善（图1B）。此外，发现治疗前升高的血清可溶性IL-2受体在给予皮质类固醇后降低（分别为1，435 U/ml和299 U/ml）。据我们所知，文献中仅报告了少数结节病引起的眼睑下垂病例，其中大多数是由于神经或肌肉结节病引起的（3-5）。在这个病例中，我们的结论是双侧上睑下垂是由于霍纳综合征，因为我们认识到双侧锁骨上淋巴结肿胀。治疗后进行的CT成像显示淋巴结肿大减少（图2B，箭头）。我们认为这是第一个报告眼睑下垂，由于
A 39-year-old woman was admitted to our hospital because an X-ray had shown a nodular shadow on her right lung. She had been clinically diagnosed with ocular and pulmonary sarcoidosis 10 years earlier but was not currently taking any medication. On admission she presented with bilateral blepharoptosis with miosis (Figure 1A). We performed bronchoscopy and made a diagnosis of pulmonary sarcoidosis on the basis of histological examination. Acetylcholine receptor antibody, tensilon, and eye movement tests revealed no abnormalities. Because brain magnetic resonance imaging also failed to demonstrate any abnormalities, we performed cervical computed tomography (CT), which revealed bilateral supraclavicular lymph node swelling (Figure 2A, arrows). We then performed positron emission tomography (PET)-CT to investigate whether lymphadenopathy was due to sarcoidosis, as PET-CT has been found to frequently represent positive activity in areas with active granulomatous lesions from sarcoidosis (1). PET-CT revealed that the supraclavicular lymph node had accumulated fluid to the same extent as the biopsied lung lesion. Accordingly, we concluded that the bilateral blepharoptosis was caused by Horner syndrome. The patient was given corticosteroid therapy (0.5 mg/kg/d) as recommended in the literature (1-3), and her bilateral blepharoptosis subsequently improved (Figure 1B). In addition, serum-soluble IL-2 receptors, which had been elevated before treatment, were found to be decreased by the administration of corticosteroids (1,435 U/ml and 299 U/ml, respectively).To our knowledge, only a few cases of blepharoptosis due to sarcoidosis have been reported in the literature, and most of these were due to neurological or muscular sarcoidosis (3-5). In this case, we concluded that bilateral blepharoptosis was due to Horner syndrome because we recognized bilateral supraclavicular lymph node swelling. CT imaging performed after treatment showed a reduction of the lymph node enlargement (Figure 2B, arrows). We believe that this is the first report of blepharoptosis due to