Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan.
Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan; Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan.
J Infect Chemother. 2023 Aug;29(8):806-808. doi: 10.1016/j.jiac.2023.04.013. Epub 2023 Apr 23.
Inhaled liposomal antimicrobials are known to cause hypersensitivity pneumonitis. Amikacin liposome inhalation suspension (ALIS) is a promising novel antimicrobial agent against refractory Mycobacterium avium complex infections. The frequency of drug-induced lung injury caused by ALIS is relatively high. To date, no reports of ALIS-induced organizing pneumonia diagnosed by bronchoscopy are available. We report a case of a 74-year-old female patient presenting with non-tuberculous mycobacterial pulmonary disease (NTM-PD). She was treated with ALIS for refractory NTM-PD. Fifty-nine days after starting ALIS, the patient developed a cough, and her chest radiographs indicated deterioration. She was diagnosed with organizing pneumonia based on pathological findings of the lung tissues obtained by bronchoscopy. After switching from ALIS to amikacin infusion, her organizing pneumonia improved. It is difficult to distinguish between organizing pneumonia and an exacerbation of NTM-PD based on chest radiography alone. Therefore, it is essential to perform an active bronchoscopy for diagnosis.
已知吸入性脂质体抗生素可引起过敏性肺炎。阿米卡星脂质体吸入混悬液（ALIS）是一种有前途的新型抗耐药鸟分枝杆菌复合感染的抗菌药物。ALIS 引起的药物性肺损伤的频率相对较高。迄今为止，尚无经支气管镜诊断的 ALIS 引起的机化性肺炎的报道。我们报告了一例 74 岁女性患者，患有非结核分枝杆菌肺病（NTM-PD）。她因难治性 NTM-PD 接受了 ALIS 治疗。在开始使用 ALIS 后 59 天，患者出现咳嗽，胸部 X 线片显示病情恶化。根据支气管镜获取的肺部组织的病理发现，患者被诊断为机化性肺炎。从 ALIS 转换为阿米卡星输注后，她的机化性肺炎得到改善。仅凭胸部 X 线片很难区分机化性肺炎和 NTM-PD 的恶化。因此，进行积极的支气管镜检查以明确诊断非常重要。
