Akoun G M, Liote H A, Liote F, Gauthier-Rahman S, Kuntz D
Department of Respiratory Medicine, Hôpital Tenon, Paris, France.
Chest. 1990 Feb;97(2):495-8. doi: 10.1378/chest.97.2.495.
A 79-year-old man was given a cumulative dose of 16.5 g of nilutamide for treatment of prostate cancer. He then presented with a respiratory illness having clinical, radiologic and functional characteristics of interstitial pneumonitis. No other cause of pneumonitis was found. Bronchoalveolar lavage showed a lymphocytic alveolitis with an inverted lymphocyte subset ratio. After an 11-week period of drug withdrawal, clinical, radiologic and functional improvement was observed along with a normal alveolar lymphocytosis. Nilutamide therapy was then resumed for five weeks and induced the recurrence of clinical, functional and alveolar abnormalities. Nilutamide treatment was finally stopped and two months later, clinical and functional abnormalities resolved. This observation seems to exemplify the possible diagnostic value of coupling provocation test with BAL cell data in hypersensitivity pneumonitis induced by drugs. In addition, these data support the role of a cell-mediated immunologic mechanism in the pathogenesis of nilutamide-induced pneumonitis.
一名79岁男性接受了累积剂量为16.5克的尼鲁米特治疗前列腺癌。随后，他出现了一种呼吸系统疾病，具有间质性肺炎的临床、放射学和功能特征。未发现其他肺炎病因。支气管肺泡灌洗显示淋巴细胞性肺泡炎，淋巴细胞亚群比例倒置。停药11周后，观察到临床、放射学和功能改善，同时肺泡淋巴细胞增多恢复正常。随后重新开始尼鲁米特治疗5周，导致临床、功能和肺泡异常复发。最终停止尼鲁米特治疗，两个月后，临床和功能异常消失。该观察结果似乎例证了在药物诱发的过敏性肺炎中，激发试验与支气管肺泡灌洗细胞数据相结合可能具有的诊断价值。此外，这些数据支持细胞介导的免疫机制在尼鲁米特诱发肺炎发病机制中的作用。
