Ohe Masashi, Shida Haruki, Horita Tetsuya, Furuya Ken
Department of Internal Medicine, JCHO Hokkaido Hospital, Sapporo 062-8618, Japan.
Transl Clin Pharmacol. 2018 Jun;26(2):60-63. doi: 10.12793/tcp.2018.26.2.60. Epub 2018 Jun 18.
A 41-year-old man suffering from eosinophilic granulomatosis with polyangiitis (EPGA), diagnosed at another clinic on the basis of American College of Rheumatology Criteria, with a history of bronchial asthma, eosinophilia, mononeuritis multiplex, and non-fixed pulmonary infiltrates, was admitted to our department for further treatment. The patient complained of chest pain that started recently. An echocardiogram identified myocardial thickening and decreased wall motion, based on which the patient was diagnosed as having EPGA with myocarditis. The patient was successfully treated using glucocorticoids, such as methyl prednisolone (PSL) and PSL in combination with cyclophosphamide (CPM). However, CPM administration was discontinued afterwards because of the risk of bone marrow toxicity, the increased eosinophilic count (EOC) that we considered as an index of disease activity. Subsequently, the patient received additional clarithromycin (CAM) and tacrolimus (TAC) treatment considering their immunomodulatory effects. As a result, the EOC decreased and the PSL dosage could be reduced. This case shows that additional CAM and TAC treatment may be beneficial in some cases of EPGA.
一名41岁男性，患嗜酸性肉芽肿性多血管炎（EPGA），根据美国风湿病学会标准在另一家诊所确诊，有支气管哮喘、嗜酸性粒细胞增多、多发性单神经炎和非固定性肺部浸润病史，因进一步治疗入住我科。患者主诉近期开始出现胸痛。超声心动图显示心肌增厚及室壁运动减弱，据此患者被诊断为EPGA合并心肌炎。患者使用甲泼尼龙（PSL）等糖皮质激素及PSL联合环磷酰胺（CPM）成功治疗。然而，由于骨髓毒性风险以及我们将嗜酸性粒细胞计数（EOC）升高视为疾病活动指标，之后停用了CPM。随后，考虑到克拉霉素（CAM）和他克莫司（TAC）的免疫调节作用，患者接受了额外的CAM和TAC治疗。结果，EOC下降，PSL剂量得以减少。该病例表明，额外的CAM和TAC治疗在某些EPGA病例中可能有益。
