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药物性急性嗜酸性粒细胞性肺炎合并纵隔气肿:一种不寻常的表现。

Drug-Induced Acute Eosinophilic Pneumonia With Pneumomediastinum: An Unusual Presentation.

作者信息

Agarwal Vasu, Nangia Sidhaant, Prasenan Shaily, Ganta Siri Vineeth A

机构信息

Respiratory Medicine, Dr. D.Y. Patil Medical College, Hospital and Research Center, Pune, IND.

Pulmonology and Critical Care, Dr. D.Y. Patil Medical College, Hospital and Research Center, Pune, IND.

出版信息

Cureus. 2024 Jul 17;16(7):e64708. doi: 10.7759/cureus.64708. eCollection 2024 Jul.

DOI:10.7759/cureus.64708
PMID:39156473
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11327844/
Abstract

A 27-year-old female, with no significant past medical history, presented to the casualty department with a two-week history of progressive dyspnea, cough, and fever. She reported that she had recently started taking a non-conventional alternative medication for her irregular menstrual cycles. Chest radiography demonstrated bilateral alveolar opacities, and computed tomography (CT) of the chest revealed bilateral ground-glass opacities and pneumomediastinum. Laboratory testing showed peripheral blood eosinophilia, and bronchoscopy with bronchoalveolar lavage confirmed an elevated eosinophil count. Based on the clinical presentation, radiographic and laboratory findings, and exclusion of other etiologies, a diagnosis of drug-induced eosinophilic lung disease with pneumomediastinum was made. The alternative non-conventional drug was immediately discontinued and the patient was treated with systemic corticosteroids, leading to a rapid improvement in her symptoms and radiographic abnormalities. A repeat CT of the chest after 15 days revealed significant resolution of the ground-glass opacities and complete resolution of pneumomediastinum. This case highlights the importance of thorough medication history and vigilance for potential adverse effects of non-conventional treatments.

摘要

一名27岁女性,既往无重大病史,因进行性呼吸困难、咳嗽和发热两周就诊于急诊科。她报告称最近开始服用一种非传统的替代药物来治疗月经周期不规律。胸部X线检查显示双侧肺泡性混浊,胸部计算机断层扫描(CT)显示双侧磨玻璃样混浊和气纵隔。实验室检查显示外周血嗜酸性粒细胞增多,支气管镜检查及支气管肺泡灌洗证实嗜酸性粒细胞计数升高。根据临床表现、影像学和实验室检查结果,并排除其他病因,诊断为药物性嗜酸性粒细胞性肺病伴气纵隔。立即停用该非传统替代药物,并给予患者全身糖皮质激素治疗,其症状和影像学异常迅速改善。15天后复查胸部CT显示磨玻璃样混浊明显消退,气纵隔完全消失。该病例凸显了详细用药史的重要性以及对非传统治疗潜在不良反应的警惕性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d4c7/11327844/094b95248f10/cureus-0016-00000064708-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d4c7/11327844/6e6082eb69ca/cureus-0016-00000064708-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d4c7/11327844/1074776105fb/cureus-0016-00000064708-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d4c7/11327844/55bbdbb598f7/cureus-0016-00000064708-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d4c7/11327844/094b95248f10/cureus-0016-00000064708-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d4c7/11327844/6e6082eb69ca/cureus-0016-00000064708-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d4c7/11327844/1074776105fb/cureus-0016-00000064708-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d4c7/11327844/55bbdbb598f7/cureus-0016-00000064708-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d4c7/11327844/094b95248f10/cureus-0016-00000064708-i04.jpg

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本文引用的文献

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A Case of Acute Eosinophilic Pneumonia Triggered by the SARS-CoV-2 Virus.一例由新型冠状病毒引发的急性嗜酸性粒细胞性肺炎病例。
Cureus. 2023 Apr 25;15(4):e38111. doi: 10.7759/cureus.38111. eCollection 2023 Apr.
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A case of cocaine-induced eosinophilic pneumonia: Case report and review of the literature.一例可卡因诱发的嗜酸性粒细胞性肺炎:病例报告及文献复习
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Clinical implications of correlation between peripheral eosinophil count and serum levels of IL-5 and tryptase in acute eosinophilic pneumonia.外周血嗜酸性粒细胞计数与急性嗜酸性粒细胞性肺炎患者血清白细胞介素-5及类胰蛋白酶水平相关性的临床意义
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Pneumomediastinum: etiology and a guide to diagnosis and treatment.气肿性纵隔炎:病因与诊断和治疗指南。
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A novel cause of eosinophilic pneumonia: recreational marijuana exposure.嗜酸性粒细胞性肺炎的一种新病因:吸食消遣性大麻。
J Bronchology Interv Pulmonol. 2013 Apr;20(2):183-5. doi: 10.1097/LBR.0b013e31828caa0d.
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Clinical significance of interleukin 33 (IL-33) in patients with eosinophilic pneumonia.白细胞介素 33(IL-33)在嗜酸粒细胞性肺炎患者中的临床意义。
Allergol Int. 2013 Mar;62(1):45-52. doi: 10.2332/allergolint.12-OA-0439. Epub 2012 Sep 25.
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