Matsushima Hidekazu, Sugita Yutaka, Yanagisawa Tsutomu, Ubukata Mikio, Kurosawa Tomonori, Yoshida Fumika, Kanazawa Minoru
Department of Pulmonary Medicine, Saitama Cardiovascular and Respiratory Center, 1696 Itai, Kohnan-machi, Ohsato-gun, Saitama 360-0105, Japan.
Kekkaku. 2003 May;78(5):401-6.
A 71-year-old male was admitted to our hospital with dyspnea on effort. He had been prescribed rifampicin, isoniazid sodium methanesulfonate (IHMS), and ethambutol for pulmonary tuberculosis, and ursodesoxycholic acid for alcoholic liver dysfunction. The chest HRCT revealed diffuse ground-glass attenuation with interlobular interstitial thickening. BALF showed lymphocytosis, and TBLB revealed organizing pneumonia. All medications were interrupted, and his respiratory failure and chest HRCT findings were improved. He started again medications excluding IHMS, his condition continued to improve further. DLST to causative IHMS was negative with peripheral blood lymphocytes, but was positive with lymphocytes from BALF. Therefore, we diagnosed this case as having IHMS induced interstitial pneumonia. In the past, 5 cases of isoniazid induced interstitial pneumonia were reported, but IHMS induced interstitial pneumonia has not been reported. Clinicians need to be aware of drug induced interstitial pneumonia by anti-tuberculosis drugs including IHMS in patients receiving anti-tuberculosis drugs.
一名71岁男性因劳力性呼吸困难入住我院。他曾因肺结核服用利福平、异烟肼甲磺酸钠（IHMS）和乙胺丁醇，因酒精性肝功能不全服用熊去氧胆酸。胸部HRCT显示弥漫性磨玻璃影伴小叶间隔增厚。BALF显示淋巴细胞增多，TBLB显示机化性肺炎。所有药物均停用，其呼吸衰竭及胸部HRCT表现均有改善。他再次开始服用除IHMS外的药物，病情继续进一步改善。对引起该病的IHMS进行的药物淋巴细胞刺激试验（DLST）在外周血淋巴细胞中为阴性，但在BALF中的淋巴细胞中为阳性。因此，我们将该病例诊断为IHMS诱发的间质性肺炎。过去曾报道过5例异烟肼诱发的间质性肺炎，但尚未有IHMS诱发间质性肺炎的报道。临床医生需要意识到在接受抗结核药物治疗的患者中，包括IHMS在内的抗结核药物可诱发药物性间质性肺炎。
