Mochizuki Eisuke, Furuhashi Kazuki, Fujisawa Tomoyuki, Enomoto Noriyuki, Inui Naoki, Nakamura Yutaro, Kono Masato, Hamada Etsuko, Maekawa Masato, Suda Takafumi
Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan; Department of Laboratory Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Respir Med Case Rep. 2015 Nov 3;16:163-5. doi: 10.1016/j.rmcr.2015.10.008. eCollection 2015.
We report a successful treatment with voriconazole (VRCZ) for chronic progressive pulmonary aspergillosis (CPPA) in a patient with dermatomyositis-associated interstitial lung disease (DM-ILD) treated with tacrolimus. A 73-year-old man with DM-ILD, treated with tacrolimus and prednisolone, complained of productive cough and his chest X-ray showed infiltration in the left upper lung field. We diagnosed CPPA and added VRCZ. Although we reduced the dose of tacrolimus for drug interaction, serum VRCZ level increased after the treatment. The patient was found to have cytochrome P450 (CYP) 2C19 *2/*2, a genetic polymorphism in poor metabolizers of VRCZ. We adjusted the doses of both drugs and treated him successfully. We recommend performing individual therapeutic drug monitoring (TDM) in CYP-mediated drug interactions and considering the effect of CYP polymorphisms.
我们报告了1例使用他克莫司治疗的皮肌炎相关间质性肺疾病（DM-ILD）患者，采用伏立康唑（VRCZ）成功治疗慢性进行性肺曲霉病（CPPA）的病例。1名73岁男性，患有DM-ILD，正在接受他克莫司和泼尼松龙治疗，主诉有咳痰，胸部X线显示左上肺野浸润。我们诊断为CPPA并加用了VRCZ。尽管我们因药物相互作用减少了他克莫司的剂量，但治疗后血清VRCZ水平仍升高。发现该患者细胞色素P450（CYP）2C19 *2/*2，这是VRCZ代谢不良者中的一种基因多态性。我们调整了两种药物的剂量并成功治愈了他。我们建议在CYP介导的药物相互作用中进行个体化治疗药物监测（TDM），并考虑CYP基因多态性的影响。
