Akoun G M, Milleron B J, Mayaud C M, Tholoniat D
Department of Chest Disease, Hôpital Tenon, University of Paris, France.
Am Rev Respir Dis. 1989 Jan;139(1):247-9. doi: 10.1164/ajrccm/139.1.247.
A 59-yr-old man was given over a 30-month period a cumulative dose of 36 g of propranolol for treatment of angina pectoris. He then presented with respiratory disease, having all the clinical, radiologic, and functional characteristics of interstitial pneumonitis. No other cause of pneumonitis was found. Bronchoalveolar lavage (BAL) showed a lymphocytic alveolitis with lymphocyte subset inverted ratio. After a 9-wk period of drug withdrawal, clinical and radiologic improvement was observed along with resolution of BAL abnormalities. Propranolol therapy was resumed for 6 wk and induced the recurrence of BAL abnormalities. Propranolol treatment was finally stopped, and 15 wk later, clinical symptoms abated, chest roentgenogram and pulmonary function tests were improved, and BAL data returned to normal. This observation seems to exemplify the possible diagnostic value of coupling provocation test with BAL cell data in some hypersensitivity pneumonitis induced by drugs. In addition, these data support the role of a cell-mediated immunologic mechanism in the pathogenesis of propranolol-induced pneumonitis.
一名59岁男性在30个月的时间里累计服用了36克普萘洛尔来治疗心绞痛。随后他出现了呼吸系统疾病，具备间质性肺炎的所有临床、放射学和功能特征。未发现其他导致肺炎的原因。支气管肺泡灌洗（BAL）显示为淋巴细胞性肺泡炎，淋巴细胞亚群比例倒置。停药9周后，观察到临床和放射学症状改善，同时BAL异常情况也得到缓解。再次进行普萘洛尔治疗6周后，BAL异常情况复发。最终停止普萘洛尔治疗，15周后，临床症状减轻，胸部X线片和肺功能测试有所改善，BAL数据恢复正常。这一观察结果似乎例证了在某些药物诱发的超敏性肺炎中，将激发试验与BAL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普萘洛尔诱发肺炎发病机制中的作用。
