Afflu Derek K, Cody Brittany A, Lendermon Elizabeth, Sanchez Pablo G
Division of Lung Transplant and Lung Failure, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
JHLT Open. 2024 May 10;5:100108. doi: 10.1016/j.jhlto.2024.100108. eCollection 2024 Aug.
This case report presents a unique and severe manifestation of drug-induced interstitial lung disease (DIILD) in an 18-year-old male with a recent history of coronavirus disease 2019 (COVID-19) infection. The patient, treated with trimethoprim-sulfamethoxazole (Bactrim) for acne, developed a rapid and aggressively progressive respiratory failure and underwent bilateral orthotopic lung transplantation. Radiologic evaluation revealed extensive bilateral bronchiectasis, ground-glass opacities/consolidation, and fibrotic changes, with diffuse vascular thrombosis observed during explant pathology. Sulfonamides, particularly Bactrim, are implicated in DIILD, with male sex and pre-existing lung disease as common risk factors. The patient's simultaneous exposure to COVID-19 and genetic susceptibility to Bactrim allergy (human leukocyte antigen (HLA) B07:02 and HLA C07:02) may have contributed to the rapid progression of pulmonary fibrosis. Despite limited literature on lung transplantation for Bactrim-induced lung fibrosis, this case underscores its consideration as a viable treatment option in refractory cases.
本病例报告展示了一名18岁男性药物性间质性肺病（DIILD）的独特且严重表现，该男性近期有2019冠状病毒病（COVID-19）感染史。该患者因痤疮接受甲氧苄啶-磺胺甲恶唑（复方新诺明）治疗后，迅速出现进行性加重的呼吸衰竭，并接受了双侧原位肺移植。放射学评估显示广泛的双侧支气管扩张、磨玻璃影/实变以及纤维化改变，在外植体病理学检查中观察到弥漫性血管血栓形成。磺胺类药物，尤其是复方新诺明，与DIILD有关，男性以及原有肺部疾病是常见的危险因素。该患者同时感染COVID-19以及对复方新诺明过敏的遗传易感性（人类白细胞抗原（HLA）B07:02和HLA C07:02）可能促使了肺纤维化的快速进展。尽管关于复方新诺明所致肺纤维化的肺移植文献有限，但本病例强调了在难治性病例中将其视为可行治疗选择的必要性。
