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[肺癌电视辅助胸腔镜肺叶切除术后同侧发生的洛索洛芬钠诱导的嗜酸性粒细胞性肺炎病例]

[Case of loxoprofen sodium-induced eosinophilic pneumonia that occurred ipsilaterally after VATS lobectomy for lung cancer].

作者信息

Izumo Takehiro, Kondo Mitsuko, Mae Masahiro, Onizawa Shigemitsu, Nagara Naoki, Nozu Tomoko, Tamaoki Jun, Ohnuki Takamasa, Nagai Atsushi

机构信息

First Department of Medicine, School of Medicine, Tokyo Women's Medical University.

出版信息

Nihon Kokyuki Gakkai Zasshi. 2007 Oct;45(10):799-803.

Abstract

A 76-year-old man was admitted because of dry cough and dyspnea two weeks after VATS lobectomy for lung cancer. Chest radiographs and computed tomography showed interstitial shadows in the only operative lung side. Although antibiotic drugs were given because we believed it to be postoperative pneumonia, abnormal shadows on chest radiographs increased. A bronchoalveolar lavage fluid (BALF) study performed on the 21" day after operation showed that the proportions of eosinophils, basophils and mast cells had increased, and the CD4/CD8 ratio was 4.42. The drug lymphocyte stimulation test for loxoprofen sodium was positive. Based on the clinical course, laboratory data and BALF study, we arrived at a diagnosis of drug-induced pneumonia caused by loxoprofen sodium. Treatment with corticosteroid resulted in marked improvement of the chest radiographs and clinical findings. Drug-induced pneumonia usually occurs bilaterally, but it occurred only on the operative side in this case. Although rare, it is important to recognize that unilateral drug-induced pneumonia is one of the differential diagnose of postoperative pneumonia.

摘要

一名76岁男性在因肺癌接受电视辅助胸腔镜肺叶切除术后两周,因干咳和呼吸困难入院。胸部X光片和计算机断层扫描显示仅在手术侧肺出现间质阴影。尽管我们认为这是术后肺炎而给予了抗生素治疗,但胸部X光片上的异常阴影仍增多。术后第21天进行的支气管肺泡灌洗(BALF)研究显示,嗜酸性粒细胞、嗜碱性粒细胞和肥大细胞的比例增加,CD4/CD8比值为4.42。洛索洛芬钠的药物淋巴细胞刺激试验呈阳性。根据临床病程、实验室数据和BALF研究,我们诊断为洛索洛芬钠引起的药物性肺炎。使用皮质类固醇治疗后,胸部X光片和临床症状明显改善。药物性肺炎通常双侧发生,但本例仅发生在手术侧。虽然罕见,但认识到单侧药物性肺炎是术后肺炎的鉴别诊断之一很重要。

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