Oketani N, Saito H, Ebe T
Department of Respiratory Medicine, Nagaoka Red Cross Hospital, Niigata, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1996 Sep;34(9):983-8.
A 72-year-old woman was admitted to our hospital because of dyspnea and abnormal shadows on a chest X-ray film. The X-ray film revealed diffuse reticular and patchy shadows in both lung fields. Drug-induced pneumonitis was suspected, and all drug treatment was stopped. The symptoms were relieved and the X-ray findings improved markedly. In bronchoalveolar lavage fluid, the lymphocyte percentage was high and the CD4/CD8 ratio was low. Microscopic examination of open-lung biopsy specimens showed pneumonitis, dominant lymphocyte invasion within peribronchiolar and alveolar interstitia. The result of leukocyte migration inhibition test was positive for Hangeshashin-to and Byakkokaninjin-to, and lymphocyte stimulation test was positive for Hange, an ingredient of Hangeshashin-to. Based on these findings, we diagnosed as pneumonitis induced by Hangeshashin-to. To our knowledge, there has been no previous report of pulmonary hypersensitivity induced by Hangeshashin-to in Japan.
一名72岁女性因呼吸困难和胸部X线片出现异常阴影而入住我院。X线片显示双肺野弥漫性网状和斑片状阴影。怀疑为药物性肺炎,遂停用所有药物治疗。症状缓解,X线表现明显改善。支气管肺泡灌洗液中淋巴细胞百分比高,CD4/CD8比值低。开胸肺活检标本显微镜检查显示肺炎,主要为淋巴细胞浸润于细支气管周围和肺泡间质。白细胞游走抑制试验对汉方柴胡汤和白虎加人参汤呈阳性,淋巴细胞刺激试验对汉方柴胡汤的成分柴胡呈阳性。基于这些发现,我们诊断为汉方柴胡汤所致肺炎。据我们所知,日本此前尚无汉方柴胡汤引起肺部超敏反应的报道。