Bando M, Takishita Y, Bando H, Hashimoto Y, Sano T
Department of Internal Medicine, Tokushima Prefectural Central Hospital, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1992 Jan;30(1):128-32.
A case of acute interstitial pneumonia developing during gold therapy is reported. A 67-year-old female with rheumatoid arthritis for about twenty years who received a total dose of 80 mg of gold thiomalate (Shiosol) for about two months, developed high fever and dry cough. Exertional dyspnea developed and chest roentgenogram showed diffuse small nodular and reticular shadows. RA and RAPA tests were positive. Drug lymphocyte stimulation test (DLST) for Shiosol was positive. The dyspnea resolved on administration of methylprednisolone. Chest roentgenogram and CT-scan showed improvement. A total dose of 80 mg of gold thiomalate, as administered in this case, is the minimum dose previously reported in Japan. It has been recently reported that allergic reaction is the mechanism of gold lung. In the present case, positive DLST indicated the existence of many activated lymphocytes, and was very useful in the diagnosis of gold lung.
报告了1例在金制剂治疗期间发生急性间质性肺炎的病例。一名67岁女性，患类风湿关节炎约20年，接受硫代苹果酸金（Shiosol）总量80mg约两个月后，出现高热和干咳。随后出现劳力性呼吸困难，胸部X线片显示弥漫性小结节和网状阴影。类风湿因子（RA）和抗环瓜氨酸肽抗体（RAPA）检测呈阳性。针对Shiosol的药物淋巴细胞刺激试验（DLST）呈阳性。给予甲泼尼龙后呼吸困难缓解。胸部X线片和CT扫描显示病情改善。本病例中使用的硫代苹果酸金总量80mg是日本此前报告的最小剂量。最近有报道称，过敏反应是金肺的发病机制。在本病例中，阳性的DLST表明存在许多活化淋巴细胞，对金肺的诊断非常有用。
