急性呼吸不全を呈した辛夷清肺湯による薬剤性肺障害の1例  [in Japanese] A CASE OF ACUTE RESPIRATORY FAILURE CAUSED BY DRUG INDUCED LUNG INJURY BY SHINISEIHAITO  [in Japanese]

今回,辛夷清肺湯によるアレルギー性機序が原因で急性呼吸促迫症候群が惹起されたと考えられる1例を経験したので報告する.【症例】84歳女性,副鼻腔炎の治療目的に辛夷清肺湯を投与され,急性間質性肺炎型薬剤性肺障害から急性呼吸促迫症候群を発症したが,内服中止とコルチコステロイド薬にて劇的に改善した.薬剤性肺障害のCamusの基準中,本例は辛夷清肺湯に対してこの基準の5項目中4項目を満たし,辛夷清肺湯による肺障害と診断した.コルチコステロイド薬減量後の辛夷清肺湯のdrug lymphocyte stimulation test (DLST)のstimulation index (SI)値が上昇しており,本例の急性間質性肺炎は辛夷清肺湯によるアレルギー性機序により誘発されたことが示唆された.辛夷清肺湯による薬剤性肺障害は本例が7件目で,投与時は注意深い観察が必要であると考えられた.

We present a case of acute respiratory distress syndrome (ARDS) caused by allergic reactions to shiniseihaito. An 84-year-old woman showed acute interstitial pneumonia followed by ARDS after taking shiniseihaito for the treatment of rhinitis. The ARDS were markedly improved with corticosteroid therapy. This case was diagnosed as being induced by shiniseihaito because it was compatible with 4 of 5 of Camus's criteria. The stimulation index of the drug lymphocyte stimulation test with shiniseihaito increased after corticosteroid therapy had been tapered and suggested that the mechanism of acute interstitial pneumonia in this case was allergic reaction induced by shiniseihaito. This is the seventh reported case of drug induced lung injury by shiniseihaito. We recommend careful observation when this medicine is prescribed.