گزارش دو ﻣﻮرد آﻟﻮﺋﻮﻻر ﻣﻴﻜﺮوﻟﻴﺘﻴﺎزﻳﺲ رﻳﻪ ﺑﻪ دﻧﺒﺎل ﻣﺠﺮوﺣﻴﺖ ﺷﻴﻤﻴﺎﺋﻲ ﺑﺎ ﮔﺎز ﺧﺮدل

Report of Two Cases of Pulmonary Alveolar Microlithiasis after Exposure to Mustard Gas

ﺁﻟﻮﺋﻮﻻﺭ ﻣﻴﻜﺮﻭﻟﻴﺘﻴﺎﺯﻳﺲ ﺭﻳﻪ [Pulmonary Alveolar Microlithiasis (PAM)] ﻳﻚ ﺑﻴﻤﺎﺭﻱ ﻧﺎﺩﺭ ﺑﺎ ﻋﻠﺖ ﻧﺎﺷﻨﺎﺧﺘﻪ ﺍﺳﺖ ﻛﻪ ﺑﺎ ﺗﻮﺳﻌﻪ، ﺗﺠﻤﻊ ﻭ ﺭﺳﻮﺏ ﻛﻠﺴﻴﻔﺮﻳﺖ )Calcispherites( ﻣﺤﺘﻮﻱ ﺍﻣﻼﺡ ﻓﺴﻔﺎﺕ ﻛﻠﺴﻴﻢ ﺑﻪ ﺻﻮﺭﺕ ﺳﻨﮕﺮﻳﺰﻩ ﻫﺎﻱ ﻣﺘﻌﺪﺩ ﺩﺭ ﺩﺍﺧﻞ ﺁﻟﻮﺋﻮﻝ ﻫﺎﻱ ﺭﻳﻮﻱ ﺷﻨﺎﺧﺘﻪ ﻣﻲ ﺷﻮﺩ. ﺩﺭ ﻧﻴﻤﻲ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﺍﺭﺗﺒﺎﻁ ﻓﺎﻣﻴﻠﻲ ﺩﻳﺪﻩ ﻣﻲ ﺷﻮﺩ. ﺩﺭ ﻣﺮﺍﺣﻞ ﭘﻴﺸﺮﻓﺘﻪ، ﺑﻴﻤﺎﺭﺍﻥ ﺩﭼﺎﺭ ﺗﻨﮕﻲ ﻧﻔﺲ، ﮔﺎﻫﻲ ﻫﻤﻮﭘﺘﺰﻱ، ﺳﺮﻓﻪ ﻫﻤﺮﺍﻩ ﺑﺎ ﻳﺎ ﺑﺪﻭﻥ ﺧﻠﻂ ﻭ ﺩﺭﺩ ﺳﻴﻨﻪ ﻣﻲ ﺷﻮﻧﺪ. ﻓﻴﺒﺮﻭﺯ ﺭﻳﻪ ﻭ ﺍﻓﺰﺍﻳﺶ ﻓﺸﺎﺭ ﺷﺮﻳﺎﻥ ﺭﻳﻪ ﺩﺭ ﻣﺮﺍﺣﻞ ﺍﻧﺘﻬﺎﻳﻲ ﺩﺭ ﺍﻏﻠﺐ ﺑﻴﻤﺎﺭﺍﻥ ﺭﺥ ﻣﻲ ﺩﻫﺪ ﻭ ﺑﺎﻋﺚ Corpulmonale ﺩﺭ ﺍﻳﻦ ﺑﻴﻤﺎﺭﺍﻥ ﻣﻲ ﮔﺮﺩﺩ. ﺑﻌﻀﻲ ﺍﺯ ﻧﻮﻳﺴﻨﺪﮔﺎﻥ ﻭﺍﻛﻨﺶ ﻫﺎﻱ ﺍﮔﺰﻭﺩﺍﺗﻴﻮ ﺣﺎﺻﻞ ﺍﺯ ﺁﺳﻴﺐ ﻫﺎﻱ ﺍﭘﻴﺘﻠﻴﻮﻡ ﺁﻟﻮﺋﻮﻝ ﻫﺎ ﺭﻳﻮﻱ ﻣﺜﻞ ﭘﻨﻮﻣﻮﻧﻲ ﻭ ﺭﻭﻣﺎﺗﻮﺋﻴﺪ ﺁﺭﺗﺮﺍﻳﺘﻴﺲ ﺭﺍ ﺩﺭ ﺍﻳﺠﺎﺩ PAM ﺩﺧﻴﻞ ﻣﻲ ﺩﺍﻧﻨﺪ. ﺩﻭ ﻣﻮﺭﺩ ﺑﻴﻤﺎﺭﻱ ﺁﻟﻮﺋﻮﻻﺭ ﻣﻴﻜﺮﻭﻟﻴﺘﻴﺎﺯﻳﺲ ﺭﻳﻪ ﺑﻪ ﺩﻧﺒﺎﻝ ﻣﺠﺮﻭﺣﻴﺖ ﺷﻴﻤﻴﺎﻳﻲ ﺑﺎ ﮔﺎﺯ ﺧﺮﺩﻝ ﺩﺭ ﺟﺒﻬﻪ ﺟﻨﮓ ﺗﺤﻤﻴﻠﻲ ﻋﺮﺍﻕ ﻋﻠﻴﻪ ﺍﻳﺮﺍﻥ ﮔﺰﺍﺭﺵ ﻣﻲ ﺷﻮﺩ. ﺩﻭ ﺑﻴﻤﺎﺭ ﻣﻮﺭﺩ ﮔﺰﺍﺭﺵ ﻣﺎ ﻫﻴﭻ ﺳﺎﺑﻘﺔ ﻓﺎﻣﻴﻠﻲ PAM ﻧﺪﺍﺷﺘﻨﺪ ﻭﻟﻲ ﺳﺎﺑﻘﻪ ﻣﺠﺮﻭﺣﻴﺖ ﺷﻴﻤﻴﺎﻳﻲ ﺑﺎ ﮔﺎﺯ ﺧﺮﺩﻝ ﺩﺍﺷﺘﻨﺪ. ﺗﺸﺨﻴﺺ ﺑﻴﻤﺎﺭﻱ ﺁﻟﻮﺋﻮﻻﺭ ﻣﻴﻜﺮﻭﻟﻴﺘﻴﺎﺯﻳﺲ ﺭﻳﻪ ﺑﺎ ﮔﺮﺍﻓﻲ ﺳﻴﻨﻪ ﻭ ﺑﻴﻮﭘﺴﻲ ﺭﻳﻪ ﺍﻧﺠﺎﻡ ﺷﺪ. ﺍﻳﻦ ﺑﻴﻤﺎﺭﻱ ﺩﺭﻣﺎﻥ ﻗﻄﻌﻲ ﻧﺪﺍﺭﺩ ﻭ ﻓﻌﻼﹰ ﺩﺭﻣﺎﻥ ﻗﻄﻌﻲ ﺁﻥ ﭘﻴﻮﻧﺪ ﺭﻳﻪ ﺍﺳﺖ.

Pulmonary alveolar microlithiasis (PAM) is a rare disease of unknown etiology and pathogenesis. This disorder is characterized by intra-alveolar development and the deposition of microliths or calcispherites containing calcium phosphate. In approximately half of the reported cases a familial connection has been found. The lung tissue is hardened progressively leading to the deterioration of pulmonary hypertension and the occurrence of cor-pulmonale. Pulmonary fibrosis is also observed in association with PAM. Some authors have suggested that PAM may be a peculiar exudative response to a variety of hurts including pneumonia and rheumatic fever. We report tow cases that manifested PAM. Their pulmonary disease began after exposure to mustard gas in Iraq-Iran war. Our patients did not have any positive familial history of the disease. The diagnosis of microlithiasis was confirmed by chest X-Ray and lung biopsy. This disease does not have any definitive treatment, but lung transplantation procedure is carried out for end stage lung disease.