プレドニゾロン投与中にニューモシスチス肺炎を発症した自己免疫性肝炎の1例  [in Japanese] A case of Pneumocystis pneumonia during receiving medication by steroid for autoimmune hepatitis  [in Japanese]

Abstract

症例は76歳女性.偶然指摘された肝胆道系酵素高値について精査し,AIHスコア7点確診例となり自己免疫性肝炎と診断した.プレドニゾロン(以下PSL)40 mg/日投与で治療を開始し,トランスアミナーゼ・IgGの改善に従ってPSLを漸減していたが,治療開始より4週目頃より発熱・咳嗽が出現した.誘発喀痰細胞診よりニューモシスチス肺炎(以下PCP)と診断,ST合剤を用いて治療を行い,症状は改善した.その間もPSL投与は中断せず,PSLを10 mg/日まで減量しトランスアミナーゼ・IgGが安定して正常範囲内にあることを確認して退院とした.PCPは,消化器領域での合併報告は多くないものの,発症すると急速に重篤な転機を辿ることもあり,早期診断・早期治療介入が必要である.消化器領域でもCorticosteroid投与の機会は少なからずあり,PCPを念頭に置いた経過観察と呼吸器症状出現の際の早期検査導入が望まれる.またPCPのハイリスクに該当する症例には,ST合剤予防投与も検討するべきである.

We present the case of a 77-year-old Japanese woman who was referred to our department due to impaired liver function. She was diagnosed as autoimmune hepatitis, classified 'definite AIH' according to Simplified diagnostic criteria of the International Autoimmune Hepatitis Group including pathological findings. Administration of prednisolone was started from the dose of 40 mg and tapered by two weeks, which resulted in a decrease of serum ALT levels. However, she developed fever and cough at the dose of 25 mg prednisolone. She was diagnosed with Pneumocyctis pneumonia by polymerase chain reaction in induced sputum sample, and then she was successfully treated with trimethoprim-sulfanethoxazone. Pneumocystis pneumonia is an opportunistic infection affecting patients with immunosuppression, and is a severe disease that can be life threatening for patients receiving immnosuppressive medication or/and steroid therapy. Today we gastroenterplogists use immunosuppressing drugs for more diseases, so we should take more attention for complication of Pneumocystis pneumonia.

Journal

Kanzo  

Kanzo 53(8), 499-505, 2012-08-25 

The Japan Society of Hepatology

References:  15

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Codes

  • NII Article ID (NAID) :
    10031039031
  • NII NACSIS-CAT ID (NCID) :
    AN00047770
  • Text Lang :
    JPN
  • Article Type :
    NOT
  • ISSN :
    04514203
  • NDL Article ID :
    023894838
  • NDL Source Classification :
    ZS21(科学技術--医学--内科学)
  • NDL Call No. :
    Z19-130
  • Databases :
    CJP  NDL  J-STAGE 

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