Goda Yasufumi, Shoji Tsuyoshi, Katakura Hiromichi
Department of Thoracic Surgery, Otsu Red Cross Hospital, 1-1-35, Nagara, Otsu, Shiga, 520-8511, Japan.
Surg Case Rep. 2020 Feb 19;6(1):40. doi: 10.1186/s40792-020-00803-2.
Acute eosinophilic pneumonia (AEP) is a rare idiopathic lung disease characterized by pulmonary eosinophilia. The epidemiology of AEP remains understudied; however, past reports have reported that AEP can be caused by an allergic reaction to medications, such as antibiotics or inhaled antigens, such as tobacco smoke. AEP usually occurs bilaterally. However, we encountered an unusual case of antibiotic-induced eosinophilic pneumonia showing unilateral consolidation just on the operative side, which was initially diagnosed as postoperative bacterial pneumonia and treated with antibiotic therapy. The prescribed antibiotics paradoxically provoked AEP and worsened the patient's condition. Here, we report this antibiotic-induced AEP case showing unilateral consolidation only on the operative side which could be triggered by surgery for primary lung cancer.
A 74-year-old man underwent right upper lobectomy for lung adenocarcinoma. On postoperative day (POD) 9, an interstitial shadow appeared in the right lower lung field of the chest radiographs, along with a fever of 38.5 °C, dyspnea needing oxygen supplementation, and increased purulent sputum production, suggesting postoperative bacterial pneumonia. Despite administration of the broad-spectrum antibiotic, meropenem, the fever did not improve, and pulmonary opacity gradually worsened. Blood analysis showed increased peripheral eosinophils at 1182/mm. The meropenem treatment was discontinued and bronchoscopy was performed for further evaluation, and the bronchoalveolar lavage fluid assessment showed a remarkable increase in the eosinophil population (51%). The drug lymphocyte stimulation test (DLST) for meropenem was positive. We diagnosed the patient with antibiotic-induced unilateral AEP, after which corticosteroid treatment was initiated. The patient subsequently improved and the infiltration in the right lower lung field completely disappeared. The patient was discharged on POD 43 without oxygen supplementation and is doing well without tumor recurrence 16 months after the surgery.
Unilateral drug-induced AEP is rare. Nonetheless, it should be recognized as a differential diagnosis of postoperative pneumonia even in cases of a unilateral radiographic infiltration, because the lung operation itself could trigger this type of AEP.
急性嗜酸性粒细胞性肺炎（AEP）是一种罕见的特发性肺部疾病，其特征为肺部嗜酸性粒细胞增多。AEP的流行病学仍未得到充分研究；然而，过去的报告称，AEP可能由对抗生素等药物的过敏反应或烟草烟雾等吸入性抗原引起。AEP通常双侧发生。然而，我们遇到了一例不寻常的抗生素诱导的嗜酸性粒细胞性肺炎病例，仅在手术侧出现单侧实变，最初被诊断为术后细菌性肺炎并接受了抗生素治疗。所开的抗生素反而引发了AEP并使患者病情恶化。在此，我们报告这例仅在手术侧出现单侧实变的抗生素诱导的AEP病例，其可能由原发性肺癌手术引发。
一名74岁男性因肺腺癌接受了右上叶切除术。术后第9天，胸部X线片显示右下肺野出现间质性阴影，伴有38.5℃发热、需要吸氧的呼吸困难以及脓性痰分泌增加，提示术后细菌性肺炎。尽管使用了广谱抗生素美罗培南，但发热并未改善，肺部混浊逐渐加重。血液分析显示外周嗜酸性粒细胞增多至1182/mm。停用美罗培南并进行支气管镜检查以进一步评估，支气管肺泡灌洗液评估显示嗜酸性粒细胞数量显著增加（51%）。美罗培南的药物淋巴细胞刺激试验（DLST）呈阳性。我们诊断该患者为抗生素诱导的单侧AEP，随后开始使用皮质类固醇治疗。患者随后病情好转，右下肺野的浸润完全消失。患者在术后第43天无需吸氧出院，术后16个月无肿瘤复发，情况良好。
单侧药物诱导的AEP罕见。尽管如此，即使在单侧影像学浸润的情况下，也应将其视为术后肺炎的鉴别诊断，因为肺部手术本身可能引发此类AEP。
