Inagaki Yuji, Tachibana Kazunobu, Inoue Yasushi, Kasai Takahiko, Inoue Yoshikazu
Department of Internal Medicine National Hospital Organization, Kinki-Chuo Chest Medical Center Osaka Japan.
Department of Anesthesiology National Hospital Organization, Kinki-Chuo Chest Medical Center Osaka Japan.
Respirol Case Rep. 2020 Feb 20;8(3):e00541. doi: 10.1002/rcr2.541. eCollection 2020 Apr.
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a type of hypersensitivity drug reaction. Here, we report the case of a 78-year-old man who presented with a rash, fever, dry cough, and swollen parotid glands who had been prescribed clopidogrel for one year. Computed tomography showed consolidation and interlobular septal thickening with enlarged mediastinal lymph nodes. As oxygen therapy was ineffective, the patient was intubated and bronchoalveolar lavage cellular analysis showed an increase in eosinophils. Clopidogrel was discontinued and the parotid biopsy revealed periductal lymphocytic infiltration. High doses of corticosteroids were administered, and his symptoms improved. However, his symptoms recurred when clopidogrel was restarted. Skin biopsy showed mild lymphocytic infiltration in the upper dermis with vasculitis, and Epstein-Barr virus (EBV) DNA was detected in his blood and lymph node tissue. On the basis of the pathology and disease manifestations, the patient was diagnosed with DRESS. Once clopidogrel treatment ceased, his symptoms never recurred.
药物超敏反应伴嗜酸性粒细胞增多和全身症状（DRESS）是一种超敏药物反应。在此，我们报告一例78岁男性病例，该患者出现皮疹、发热、干咳和腮腺肿大，已服用氯吡格雷一年。计算机断层扫描显示有实变和小叶间隔增厚，纵隔淋巴结肿大。由于氧疗无效，患者接受插管，支气管肺泡灌洗细胞分析显示嗜酸性粒细胞增多。停用氯吡格雷，腮腺活检显示导管周围淋巴细胞浸润。给予高剂量皮质类固醇，其症状改善。然而，重新开始服用氯吡格雷时症状复发。皮肤活检显示真皮上层有轻度淋巴细胞浸润伴血管炎，血液和淋巴结组织中检测到爱泼斯坦-巴尔病毒（EBV）DNA。根据病理和疾病表现，该患者被诊断为DRESS。一旦停止氯吡格雷治疗，其症状未再复发。
