ヒト免疫不全ウイルス感染血友病 B 患者に認められた ST 合剤による薬剤性肺炎の1例 Sulfamethoxazole-trimethoprim-induced Pneumonitis in a Patient with Hemophilia B who was Infected with the Human Immunodeficiency Virus

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症例は25歳, 男性. ヒト免疫不全ウイルス (HIV) 感染による著しい免疫能低下が認められていた. カリニ肺炎 (PCP) に対し sulfamethoxazole-trimethoprim (ST) 合剤の予防投与を開始したところ, <sup>67</sup>Gaシンチグラムで両肺野にびまん性の集積像, CTで肺間質に網状影の増加を認めた. 米国防疫センターの後天性免疫不全症候群の診断基準に準拠し, これらの画像所見はPCPによるものと診断し, ST合剤を継続した. しかし間質性肺炎を示唆する画像所見は発熱, 皮疹, 肝障害の出現に一致して増悪した. 気管支肺胞洗浄でカリニ原虫は検出されず, ST合剤の中止後に症状, 肝機能検査値, 画像所見は軽快した. 本症例の間質性肺炎像は, ST合併が原因となった薬剤性の肺障害による変化と臨床的に診断した. ST合剤はPCPに対し第一選択薬だが, HIV感染患者では副作用の出現頻度が高い. ST合剤が投与されているHIV感染患者では, 同剤による肺障害の可能性に留意すべきと考えられた.

Severe cellular immunosupression developed in a 25-year-old man with hemophilia B who was infected with the human immunodeficiency virus (HIV). Four days after administration of sulfamethoxazole-trimethoprim (SMX-TMP) for prophylaxis against <i>Pneumocystis carinii</i> pneumonia (PCP), diffuse uptake by both lungs was comfirmed on a <sup>67</sup>Ga scintigram. Reticular shadows were also seen throughout both lung fields on a chest CT scan. These findings were compatible with PCP, according to the guidelines for presumptive diagnosis of the acquired immunodeficiency syndrome, published by the Centers for Disease Control and Prevention. The dose of SMX-TMP was increased, but interstitial pneumonitis worsened and was accompanied by fever, skin rash, and liver dysfunction, which are common in HIV-infected patients recieving SMX-TMP. No evidence of PCP or of any other opportunistic infection was found by bronchoalveolar lavage. Adverse reactions diminished after SMX-TMP administration was stopped. The <sup>67</sup>Ga scintigram and chest CT findings also retumed to normal. We concluded that the interstitial pneumonitis was induced by SMX-TMP. SMX-TMP is the first-choice anti-PCP drug, but a high incidence of adverse reactions in patients with HIV infection has been reported. Therefore the possibility of SMX-TMP-related pulmonary toxicity must be considered in HIV-infected patients.

収録刊行物

  • 日本胸部疾患学会雑誌 = The Japanese journal of thoracic diseases

    日本胸部疾患学会雑誌 = The Japanese journal of thoracic diseases 34(7), 822-828, 1996-07-25

    The Japanese Respiratory Society

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各種コード

  • NII論文ID(NAID)
    10008110552
  • NII書誌ID(NCID)
    AN00187758
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    03011542
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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