Miyashita N, Nakajima M, Kuroki M, Kawabata S, Hashiguchi K, Niki Y, Kawane H, Matsushima T
Department of Medicine, Kawasaki Medical School, Okayama, Japan.
Nihon Kokyuki Gakkai Zasshi. 1998 Aug;36(8):684-9.
We report on two patients with sulbactam/ampicillin (SBT/ABPC)-induced pneumonitis. Both patients were being treated with SBT/ABPC for respiratory-tract infections. Following the initiation of SBT/ABPC chemotherapy, however, chest X-ray films showed a shift of shadow in patient 1 and new pulmonary infiltration shadows in patient 2. Bronchoalveolar lavage fluid (BALF) findings showed a marked increase in the total cell count and percentage of eosinophils in patient 1 and of lymphocytes in patient 2. The results of lymphocyte stimulation tests were SBT/ABPC positive for both patients. SBT/ABPC therapy was therefore discontinued and corticosteroid therapy started. Both patients were subsequently relieved of their symptoms demonstrated significantly lower and pulmonary infiltrate levels. Based on these findings, both patients were given a diagnosis of SBT/ABPC-induced pneumonitis. It has been widely reported that CD 4/CD 8 ratio in BALF decreases in cases of drug-induced pneumonitis. However, some reports have cited increase in the CD 4/CD 8 ratio. In our two patients as well, the CD 4/CD 8 ratio increased. These results, together with the findings from several other case reports, indicate that the CD 4/CD 8 ratio may not be good basis for diagnosing drug-induced pneumonitis. Recently, the incidence of drug-induced pneumonitis has been rising. To our knowledge this is the first report documenting cases of SBT/ABPC-induced pneumonitis.
我们报告了两例由舒巴坦/氨苄西林（SBT/ABPC）引起的肺炎病例。两名患者均因呼吸道感染接受SBT/ABPC治疗。然而，在开始SBT/ABPC化疗后，胸部X光片显示患者1的阴影有移位，患者2出现新的肺部浸润阴影。支气管肺泡灌洗（BALF）结果显示，患者1的总细胞数和嗜酸性粒细胞百分比显著增加，患者2的淋巴细胞百分比显著增加。两名患者的淋巴细胞刺激试验结果均为SBT/ABPC阳性。因此，停用SBT/ABPC治疗并开始使用皮质类固醇治疗。随后，两名患者的症状均得到缓解，肺部浸润水平显著降低。基于这些发现，两名患者均被诊断为SBT/ABPC引起的肺炎。已有广泛报道称，药物性肺炎患者的BALF中CD4/CD8比值会降低。然而，一些报道称该比值会升高。在我们的两名患者中，CD4/CD8比值也升高了。这些结果以及其他几例病例报告的结果表明，CD4/CD8比值可能不是诊断药物性肺炎的良好依据。近年来，药物性肺炎的发病率一直在上升。据我们所知，这是第一份记录SBT/ABPC引起的肺炎病例的报告。
