Oishi Y, Sando Y, Tajima S, Maeno T, Maeno Y, Sato M, Hosono T, Suga T, Kurabayashi M, Nagai R
Second Department of Internal Medicine, Gunma University, School of Medicine, University of Tokyo, Tokyo, Japan.
Respirology. 2001 Mar;6(1):57-60. doi: 10.1046/j.1440-1843.2001.00297.x.
Indomethacin is one of the most popular non-steroidal anti-inflammatory drugs (NSAID). Although NSAID occasionally provoke bronchospasm and hypersensitivity pneumonia, they seldom cause lymphadenopathy. This is the first report in which NSAID induced both eosinophilic pneumonia and bulky intrathoracic lymphadenopathy simultaneously. A 76-year-old Japanese man experienced high fever and dyspnoea after using an indomethacin suppository. Computed tomography scan of his chest revealed massive mediastinal and hilar lymphadenopathy along with diffuse infiltration in both lungs. He was diagnosed to have eosinophilic pneumonia because of eosinophilia in his peripheral blood and bronchoalveolar lavage fluid (BALF). Without using glucocorticoids, the pulmonary infiltration and lymphadenopathy subsided spontaneously. As the blastoid transformation test using the lymphocytes in his BALF was positive to indomethacin, we judged that both his eosinophilic pneumonia and mediastinal lymphadenopathy were due to a hypersensitivity reaction to indomethacin. An allergic reaction to NSAID should be considered as a rare cause of mediastinal lymphadenopathy.
吲哚美辛是最常用的非甾体抗炎药（NSAID）之一。虽然NSAID偶尔会引发支气管痉挛和过敏性肺炎，但很少引起淋巴结病。这是第一例NSAID同时诱发嗜酸性粒细胞性肺炎和巨大胸腔内淋巴结病的报告。一名76岁的日本男性在使用吲哚美辛栓剂后出现高热和呼吸困难。胸部计算机断层扫描显示纵隔和肺门淋巴结肿大，同时双肺弥漫性浸润。由于外周血和支气管肺泡灌洗液（BALF）中嗜酸性粒细胞增多，他被诊断为嗜酸性粒细胞性肺炎。未使用糖皮质激素，肺部浸润和淋巴结病自行消退。由于用他的BALF中的淋巴细胞进行的母细胞转化试验对吲哚美辛呈阳性，我们判断他的嗜酸性粒细胞性肺炎和纵隔淋巴结病均归因于对吲哚美辛的过敏反应。对NSAID的过敏反应应被视为纵隔淋巴结病的罕见原因。
