Kobashi Y, Nakajima M, Niki Y, Matsushima T
Department of Medicine, Kawasaki Medical School, Kurashiki, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1997 Dec;35(12):1372-7.
A 16-year-boy who had taken a common over-the-counter cold remedy containing Sho-saiko-to, presented with fever, severe cough, sputum and dyspena. Two days later, he was admitted because a negative density, pulmonary edema-like shadow was noted on chest X-ray. A diagnosis of drug-induced pneumonia was strongly suspected, because an arterial blood gas analysis showed severe hypoxemia and leukocytosis with eosinophilia, and the chest X-ray showed a diffuse negative density pulmonary edema like shadow bilaterally. The findings on microscopic examination of transbronchial lung biopsy specimens were compatible with eosinophilic pneumonia. The eosinophil percentage in the bronchoalveolar lavage fluid was high. The result of a lymphocyte-stimulation test was positive for Sho-saiko-to, and Sho-saiko-to-induced pneumonia was strongly suspected. The patient ceased taking the cold remedy, and prednisolone was given. The clinical symptoms, severe hypoxemia, and chest X-ray findings markedly improved. To the best of our knowledge, there have been no previous reports of acute eosinophilic pneumonia induced by Sho-saiko-to.
一名16岁男孩服用了一种含有小柴胡汤的普通非处方感冒药后，出现发热、剧烈咳嗽、咳痰和呼吸困难。两天后，因胸部X线检查发现低密度、类似肺水肿的阴影而入院。由于动脉血气分析显示严重低氧血症、白细胞增多伴嗜酸性粒细胞增多，且胸部X线显示双侧弥漫性低密度肺水肿样阴影，故强烈怀疑为药物性肺炎。经支气管肺活检标本的显微镜检查结果与嗜酸性粒细胞性肺炎相符。支气管肺泡灌洗液中的嗜酸性粒细胞百分比很高。淋巴细胞刺激试验结果显示对小柴胡汤呈阳性，因此强烈怀疑为小柴胡汤诱发的肺炎。患者停止服用感冒药，并给予泼尼松龙。临床症状、严重低氧血症和胸部X线表现明显改善。据我们所知，此前尚无小柴胡汤诱发急性嗜酸性粒细胞性肺炎的报道。
