Tsuchiya Kazuo, Toyoshima Mikio, Suda Takafumi
Department of Respiratory Medicine, Hamamatsu Rosai Hospital, Japan.
Second Department of Internal Medicine, Hamamatsu University School of Medicine, Japan.
Intern Med. 2017 Oct 1;56(19):2623-2626. doi: 10.2169/internalmedicine.8779-16. Epub 2017 Sep 6.
A 78-year-old man presented with acute-onset fever and dyspnea. He had been taking Sho-seiryu-to for allergic rhinitis. A chest radiograph showed diffuse bilateral ground-glass opacities with subpleural sparing, crazy-paving pattern, and traction bronchiectasis. The patient's bronchoalveolar lavage fluid was bloody and transbronchial lung biopsy specimens showed alveolitis, organizing pneumonia, and type 2 alveolar epithelial cell proliferation. There were no clinical and laboratory findings suggestive of respiratory tract infection or connective tissue disease. Based on the clinical course and the exclusion of other etiologies, Sho-seiryu-to-induced pneumonitis with diffuse alveolar hemorrhage was considered. The patient's pneumonitis resolved after the discontinuation of the drug and the administration of systemic corticosteroid therapy.
一名78岁男性出现急性发热和呼吸困难。他一直在服用小青龙汤治疗过敏性鼻炎。胸部X光片显示双侧弥漫性磨玻璃影，伴胸膜下 sparing、铺路石样改变和牵拉性支气管扩张。患者的支气管肺泡灌洗 fluid 呈血性，经支气管肺活检标本显示肺泡炎、机化性肺炎和2型肺泡上皮细胞增生。没有临床和实验室检查结果提示呼吸道感染或结缔组织病。根据临床病程及排除其他病因，考虑为小青龙汤诱发的肺炎伴弥漫性肺泡出血。停用该药并给予全身糖皮质激素治疗后，患者的肺炎得到缓解。
