Tintner Ron, Manian Prasad, Gauthier Polly, Jankovic Joseph
Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, USA.
Arch Neurol. 2005 Aug;62(8):1290-5. doi: 10.1001/archneur.62.8.1290.
Dopamine agonists are increasingly used in the treatment of Parkinson disease, but they may cause serious adverse effects. In December 1983, symptoms of Parkinson disease developed in a 55-year-old man with no history of pulmonary disease, smoking, or asbestos exposure. He began treatment with dopamine agonists bromocriptine mesylate (in 1984) and pergolide mesylate (in 1989). In late 2000, pulmonary symptoms developed. Chest radiographs and computed tomographic findings showed a mass in the right upper lobe and effusion. A biopsy specimen showed pleural and parenchymal fibrosis. This syndrome resolved after cessation of pergolide therapy and a switch to pramipexole dihydrochloride. This case draws attention to the association of long-term ergot dopamine agonist therapy with pleuropulmonary fibrosis, which can develop as late as 11 years after the initiation of therapy. We also review evidence that the risk of this complication is substantially lower with the newer nonergot dopamine agonists.
多巴胺激动剂越来越多地用于治疗帕金森病，但它们可能会引起严重的不良反应。1983年12月，一名55岁的男性出现帕金森病症状，他没有肺部疾病、吸烟或接触石棉的病史。他于1984年开始使用多巴胺激动剂甲磺酸溴隐亭治疗，1989年开始使用甲磺酸培高利特治疗。2000年末，出现肺部症状。胸部X光片和计算机断层扫描结果显示右上叶有一个肿块和胸腔积液。活检标本显示胸膜和实质纤维化。停用培高利特治疗并改用盐酸普拉克索后，该综合征得到缓解。该病例提醒人们注意长期使用麦角多巴胺激动剂治疗与胸膜肺纤维化之间的关联，这种关联可能在治疗开始后长达11年才出现。我们还回顾了证据，表明新型非麦角多巴胺激动剂出现这种并发症的风险要低得多。
