Kai Naoko, Shirai Ryo, Hirata Norio, Iwata Atsuko, Umeki Kenji, Ishii Hiroshi, Kishi Kenji, Tokimatsu Issei, Hiramatsu Kazufumi, Kadota Jun-ichi
Department of Internal Medicine 2, Oita University Faculty of Medicine.
Nihon Kokyuki Gakkai Zasshi. 2009 Mar;47(3):254-8.
A case of eosinophilic pneumonia due to Nicolase (serrapeptase) after recovery from acute eosinophilic pneumonia is described. A 32-year-old woman was previously admitted to another hospital because of acute onset of dyspnea accompanied by cough and fever. Chest X-ray films revealed diffuse infiltration in both lungs two days after her symptoms occurred. Her bronchoalveolar lavage fluid showed 13% eosinophils and transbronchial lung biopsy specimen also showed many eosinophils infiltrating in the lesions of the bronchial submucosa and alveolar septa. No infectious causes or related drugs were found. Acute eosinophilic pneumonia was diagnosed, and her condition improved gradually without steroid treatment. Because she recovered clinically and radiologically, she was discharged from hospital. Half a month later she was treated with Nicolase because of pharyngitis. She was admitted to the hospital again because of dyspnea, cough and fever three days after commencing to take Nicolase. Chest X-ray films also revealed diffuse infiltration in both lungs with pleural effusion, and her bronchoalveolar lavage fluid showed 37% eosinophils. When the drug lymphocyte stimulation test was performed, it was positive for Nicolase. Therefore drug-induced eosinophilic pneumonia was diagnosed. This is a very rare case of Nicolase (serrapeptase)-induced eosinophilic pneumonia after recovering from acute eosinophilic pneumonia.
本文描述了1例急性嗜酸性粒细胞性肺炎康复后因尼可来酶（舍雷肽酶）诱发嗜酸性粒细胞性肺炎的病例。一名32岁女性因急性起病的呼吸困难伴咳嗽、发热，曾入住另一家医院。症状出现两天后胸部X线片显示双肺弥漫性浸润。其支气管肺泡灌洗液显示嗜酸性粒细胞占13%，经支气管肺活检标本也显示支气管黏膜下层和肺泡间隔病变中有许多嗜酸性粒细胞浸润。未发现感染病因或相关药物。诊断为急性嗜酸性粒细胞性肺炎，未经类固醇治疗其病情逐渐好转。因其临床和影像学表现均恢复，故出院。半月后因咽炎接受尼可来酶治疗。开始服用尼可来酶三天后，因呼吸困难、咳嗽和发热再次入院。胸部X线片也显示双肺弥漫性浸润伴胸腔积液，其支气管肺泡灌洗液显示嗜酸性粒细胞占37%。进行药物淋巴细胞刺激试验时，尼可来酶呈阳性。因此诊断为药物性嗜酸性粒细胞性肺炎。这是1例非常罕见的急性嗜酸性粒细胞性肺炎康复后由尼可来酶（舍雷肽酶）诱发嗜酸性粒细胞性肺炎的病例。
