Uji Masato, Sugama Yoshimi, Matsushita Haruhiko
Department of Internal Medicine, Izumi City Hospital.
Nihon Kokyuki Gakkai Zasshi. 2005 Mar;43(3):150-4.
An 82-year-old man had been treated by carbamazepine for convulsions. A month later he felt febrile and malaise. Laboratory data revealed liver dysfunction, hypoxemia, and chest radiograph and computed tomography (CT) of the thorax showed ground glass opacity in both lungs and mediastinal lymphadenopathy. Analysis of bronchoalveolar lavage fluid revealed pulmonary lymphocytosis. Drug-induced lymphocyte stimulation test (DLST) for carbamazepine using peripheral blood lymphocytes was negative. We gave him a possible diagnosis of carbamazepine-induced liver damage and pneumonitis. After stopping carbamazepine, we initiated corticosteroid therapy and he recovered well. One year later he again suffered from convulsions and was treated with carbamazepine in another hospital. A week later he became febrile and suffered appetite loss, and came to our hospital. His chest radiograph and CT again showed ground glass opacity and pleural effusion in both lungs. Along with the laboratory data we established a definitive diagnosis of carbamazepine-induced pneumonitis. We discuss the mechanism of carbamazepine-induced pneumonitis in which the DLST results were negative and the challenge test was positive.
一名82岁男性曾接受卡马西平治疗惊厥。一个月后，他感到发热和不适。实验室检查显示肝功能障碍、低氧血症，胸部X线片和胸部计算机断层扫描（CT）显示双肺磨玻璃影及纵隔淋巴结肿大。支气管肺泡灌洗 fluid分析显示肺淋巴细胞增多。使用外周血淋巴细胞进行的卡马西平药物诱导淋巴细胞刺激试验（DLST）为阴性。我们给他做出了卡马西平所致肝损伤和肺炎的可能诊断。停用卡马西平后，我们开始使用皮质类固醇治疗，他恢复良好。一年后，他再次出现惊厥，在另一家医院接受卡马西平治疗。一周后，他发热且食欲不振，来到我院。他的胸部X线片和CT再次显示双肺磨玻璃影及胸腔积液。结合实验室检查结果，我们确诊为卡马西平所致肺炎。我们讨论了卡马西平所致肺炎的机制，其中DLST结果为阴性而激发试验为阳性。 （注：原文中“bronchoalveolar lavage fluid”有误，应为“bronchoalveolar lavage fluid”，意为“支气管肺泡灌洗液体” ，这里统一翻译为“支气管肺泡灌洗 fluid” ）
