Hatakeyama S, Tachibana A, Morita M, Suzuki K, Okano H
Department of Respiratory Medicine, Yaizu Municipal Hospital, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1997 Feb;35(2):210-4.
A 70-year-old man was given a diagnosis of small cell lung cancer because of the findings of examination of a specimen obtained by transbronchial lung biopsy from the rS4 a. He was treated with 2 courses of neoadjuvant chemotherapy (CBDCA, Etoposide) and underwent right middle lobectomy. He was then given 3 courses of adjuvant chemotherapy (CBDCA, Etoposide) as an inpatient and received oral etoposide (50 mg/day) as an outpatient. He was then admitted to our hospital because of dyspnea and fever. A chest-X-ray film showed reticulonodular shadows in both lung fields and blood gas analysis showed marked hypoxemia. A differential cell count of bronchoalveolar lavage fluid showed a high level of lymphocytes; and examination of a specimen obtained by transbronchial lung biopsy revealed edema of the alveolar walls, lymphocyte infiltration, and marked proliferation of type II alveolar epithelial cells. Administration of etoposide was stopped and steroid therapy was given. The symptoms, hypoxemia, and bilateral reticulonodular shadows resolved. The clinical course along with the findings from examination of bronchoalveolar lavage fluid and of the biopsy specimen, suggest that this patient had drug pneumonitis caused by oral etoposide.
一名70岁男性因经支气管肺活检从右肺上叶获取的标本检查结果被诊断为小细胞肺癌。他接受了2个疗程的新辅助化疗（顺铂、依托泊苷），并接受了右肺中叶切除术。随后，他作为住院患者接受了3个疗程的辅助化疗（顺铂、依托泊苷），并作为门诊患者接受口服依托泊苷（50毫克/天）治疗。之后，他因呼吸困难和发热入住我院。胸部X线片显示双肺野有网状结节阴影，血气分析显示明显低氧血症。支气管肺泡灌洗液体细胞分类计数显示淋巴细胞水平升高；经支气管肺活检获取的标本检查显示肺泡壁水肿、淋巴细胞浸润以及II型肺泡上皮细胞明显增生。依托泊苷停用，并给予类固醇治疗。症状、低氧血症和双侧网状结节阴影均消失。临床病程以及支气管肺泡灌洗液体和活检标本的检查结果提示，该患者患有口服依托泊苷引起的药物性肺炎。
