来氟米特与甲氨蝶呤合用所致的间质性肺炎

Leflunomide combined with methotrexate resulting in interstitial pneumonia

1例77岁女性患者,因类风湿关节炎开始服用来氟米特(LEF)20mg,每天1次,甲氨蝶呤(MTX)12.5mg,每周1次。5个月后出现发热、喘憋、咳嗽、咳痰等症状,发热后第5天停用LEF和MTX。胸部CT:双肺野弥漫性磨玻璃阴影。肺泡灌洗液:细胞总数0.49×106mL-1,巨噬细胞58.50%,淋巴细胞41.50%,中性粒细胞0.00%,嗜酸性粒细胞0.00%,肺孢子菌肺炎阴性。诊断:细菌性肺炎、间质性肺炎(药源性)。治疗:给予吸氧、抗感染、抗炎、利尿、化痰平喘及对症支持治疗,低盐低脂糖尿病饮食。糖皮质激素治疗3d后患者体温恢复正常,10d后复查胸片和胸部CT提示肺间质病变有好转,胸部超声提示胸水较前明显减少。

A 77-year-old female patient with rheumatoid arthritis （RA） was seen because of fever, dyspnea, cough, purulent sputum and interstitial lung changes. LEF （20 mg/day） combined with MTX（12.5mg/week） began before 5 months. The withdrawal of LEF and MTX was on the fifth day after the fever, the chest CT revealed ground glass shadowing and consolidations forming a mosaic pattern in lung fields; bronchi alveolar lavage （BAL） cell： total was 0.49x106/ml, macrophages 58.50%, lymphocytes 41.50%, neutrophils 0.00%, eosinophils 0.00%, PCP negative. Pneumonia, Interstitial Pneumonia （drug- induced ） were diagnosed. The patient underwent oxygen therapy, anti-infection , anti-inflammatory, diuretics, spasmolysis, with low salt and fat diet. The patient＇s temperature returned to normal after a three days of steroid hormones, the lung lesion was significantly improved on chest X-ray and CT 10 days later, and also pleural effusion was reduced on ultrasonic testing.