Uyar Meral, Elbek Osman, Bayram Nazan, Ekiz Sule, Bakir Kemal, Dikensoy Oner
Department of Pulmonary Diseases, University of Gaziantep, School of Medicine, Gaziantep, Turkey.
Respirology. 2009 May;14(4):612-3. doi: 10.1111/j.1440-1843.2009.01530.x.
Diffuse alveolar haemorrhage (DAH) is indicated by the presence of red blood cells, fibrin and haemosiderin deposits in the lung parenchyma. We present a case of DAH in a 25-year-old male following 5-nitroimidazole treatment. The first episode of haemoptysis occurred following metronidazole treatment 10 months previously. The second episode of haemoptysis occurred following ornidazole treatment 10 days before admission. During his first admission, the patients haemoglobin concentration decreased to 40 g/L. The CXR was normal, whereas high resolution CT of the lungs revealed a diffuse acinonodular pattern. Serological tests for connective tissue diseases were negative. The haemorrhagic appearance of the BAL fluid obtained during fibreoptic bronchoscopy was consistent with DAH. Microbiological analysis of the BAL fluid showed no evidence for bacterial or mycobacterial infection. Haemosiderin laden macrophages were detected in BAL fluid and lung biopsy specimens. DAH due to use of 5-nitroimidazole was diagnosed on the basis of the patient's previous history and complete recovery following treatment with corticosteroid. This is the first reported case of DAH due to use of 5-nitroimidazole. Physicians should be aware of this side-effect when prescribing this group of drugs to patients.
弥漫性肺泡出血（DAH）表现为肺实质内存在红细胞、纤维蛋白和含铁血黄素沉积。我们报告一例25岁男性在接受5-硝基咪唑治疗后发生DAH的病例。首次咯血发作发生在10个月前甲硝唑治疗之后。第二次咯血发作发生在入院前10天奥硝唑治疗之后。患者首次入院期间，血红蛋白浓度降至40g/L。胸部X光片正常，而肺部高分辨率CT显示弥漫性腺泡结节样改变。结缔组织病的血清学检查为阴性。纤维支气管镜检查期间获得的支气管肺泡灌洗（BAL）液的出血表现与DAH一致。BAL液的微生物学分析未发现细菌或分枝杆菌感染的证据。在BAL液和肺活检标本中检测到含铁血黄素巨噬细胞。根据患者既往病史及糖皮质激素治疗后完全康复，诊断为5-硝基咪唑所致的DAH。这是首例报道的因使用5-硝基咪唑导致的DAH病例。医生在给患者开这类药物时应注意这种副作用。
