Hara A, Sakamoto O, Matsumoto M, Sakata T, Kohrogi H, Sugimoto M, Ando M, Araki S, Iwakiri T
First Department of Internal Medicine, Kumamoto University Medical School, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1992 Sep;30(9):1743-8.
Bucillamine [N-(2-mercapto-2-methylpropionyl)-L-cysteine] is an anti-rheumatic drug which was developed in Japan. Interstitial pneumonia induced by bucillamine has been reported in two patients with rheumatoid arthritis. In this report, we describe another patient who developed bucillamine-induced interstitial pneumonia. In August 1990, a 53-year-old man was admitted because of fever, dry cough and dyspnea on exertion (DOE). Five months previously, he had noted polyarthritis, and treatment with bucillamine was started in May 1990. His polyarthritis improved about 2.5 months after starting bucillamine, but he developed fever, dry cough, and DOE in August 1990. Chest X-ray on admission showed diffuse acinar and interstitial shadows predominantly in the bilateral upper lung fields. Pulmonary function tests revealed decreased vital capacity and diffusing capacity. Arterial blood gas (ABG) analysis revealed moderate hypoxemia with PaO2 67 Torr. After stopping bucillamine, the fever, dry cough, and DOE improved gradually, and the abnormal shadows on chest X-ray and ABG analysis showed moderate improvements. Bronchoalveolar lavage studies showed that total cell counts and proportion of lymphocytes were increased, and CD4+/CD8+ ratio of T cell subsets was decreased to 0.56. Transbronchial lung biopsy specimen revealed lymphocytic alveolitis and mild interstitial thickening. Lymphocyte stimulation test to bucillamine was negative, but patch test with bucillamine was positive. From the patient's clinical course, laboratory data, and pathologic findings, we concluded that this is a case of bucillamine-induced interstitial pneumonia. After treatment with corticosteroid, his chest X-ray and pulmonary function test showed marked improvements.(ABSTRACT TRUNCATED AT 250 WORDS)
青霉胺[N-(2-巯基-2-甲基丙酰基)-L-半胱氨酸]是一种在日本研发的抗风湿药物。有报道称，两名类风湿关节炎患者出现了由青霉胺诱发的间质性肺炎。在本报告中，我们描述了另一例发生青霉胺诱发间质性肺炎的患者。1990年8月，一名53岁男性因发热、干咳和劳力性呼吸困难入院。5个月前，他出现多关节炎，于1990年5月开始使用青霉胺治疗。开始使用青霉胺约2.5个月后，他的多关节炎有所改善，但在1990年8月出现了发热、干咳和劳力性呼吸困难。入院时胸部X线显示双侧上肺野主要为弥漫性腺泡和间质阴影。肺功能测试显示肺活量和弥散量下降。动脉血气(ABG)分析显示中度低氧血症，动脉血氧分压(PaO2)为67托。停用青霉胺后，发热、干咳和劳力性呼吸困难逐渐改善，胸部X线和ABG分析的异常阴影也有中度改善。支气管肺泡灌洗研究显示，总细胞计数和淋巴细胞比例增加，T细胞亚群的CD4+/CD8+比值降至0.56。经支气管肺活检标本显示淋巴细胞性肺泡炎和轻度间质增厚。对青霉胺的淋巴细胞刺激试验为阴性，但青霉胺斑贴试验为阳性。根据患者的临床病程、实验室数据和病理结果，我们得出结论，这是一例青霉胺诱发的间质性肺炎。使用皮质类固醇治疗后，他的胸部X线和肺功能测试显示明显改善。(摘要截选至250字)
