美沙拉嗪致嗜酸粒细胞肺炎1例并文献复习

Mesalazine-induced eosinophilic pneumonia：a case report and literature review

目的 探讨美沙拉嗪导致嗜酸粒细胞肺炎（eosinophilic pneumonia,EP）的临床特征、诊断、治疗以及预后.方法 回顾性分析北京积水潭医院收治的1例美沙拉嗪所致EP临床资料并进行相关文献复习.分别以“mesalazine（5-aminosalicylate）”和“eosinophilic pneumonia”或“Lung”为检索词通过Pubmed、Embase及Cochrane数据库进行检索,检索时间为1987年8月至2015年9月;以“美沙拉嗪（5氨基水杨酸）”和“嗜酸粒细胞肺炎”或“肺”为检索词通过“中国期刊网全文数据库（CNKI）”和万方数据库进行检索,检索时间为1994年1月至2015年9月.结果 本例为56岁女性,在未确诊炎症性肠病情况下自行服用“美沙拉嗪”1个月后出现干咳、发热,外周血白细胞（WBC） 25.54＆#215;109/L,嗜酸粒细胞（EOS） 5.57＆#215;109/L （21.8％）.肺CT显示双侧浸润影;BALF中EOS比例33％;肺功能示DL CO为46％预计值.停药后症状及影像很快改善,但2个月后DL CO仍低.在以上检索文献中共报道美沙拉嗪所致EP 9例.包括本例共10例患者,男3例,女7例,年龄23～56岁,平均34.5岁.主要表现为干咳、发热;胸部CT显示双肺浸润影;外周血及BALF中EOS升高.肺功能显示限制性通气功能障碍及DLCO降低.停用美沙拉嗪后症状及影像完全恢复.结论 美沙拉嗪导致的EP罕见,症状及影像不特异.诊断依赖于用药史、外周血、BALF中EOS升高或活检肺组织有EOS浸润.用药过程中出现不能解释的呼吸系统表现应警惕美沙拉嗪导致EP的可能,应及时停药.本病预后良好.

Objective To explore the clinical manifestation,diagnosis,management and prognosis of mesalazine-induced eosinophilic pneumonia.Methods The clinical data of a patient with mesalazine-induced eosinophilic pneumonia admitted to Beijing Jishuitan Hospital were retrospectively analyzed and the related literature was reviewed.We searched databases PubMed,Embase,Cochrane,Wanfang and Chinese National Knowledge infrastructure （CNKI） using the keyword ＆quot;mesalazine （5-aminosalicylate）＆quot;and ＆quot;eosinophilic pneumonia＆quot; or ＆quot;lung＆quot; from January 1994 to September 2015.Results The patient was a 56-year-old woman who underwent mesalazine treatment,though in the absence of established criteria required for diagnosing inflammatory bowel disease.She developed dry cough and fever 1 month after the beginning of the treatment.A blood test showed a white blood cell （WBC） count of 25.54 ＆#215; 109/L and a severe eosinophilia of 5.57 ＆#215; 109/L （21.8%）.Her CT scan revealed bilateral pulmonary infiltrates.Bronchoalveolar lavage findings showed an increased percentage of eosinophils （33%）.The diffusing capacity of the lung for carbon monoxide （DLCO） was 46% of the predicted values.Improvement in clinical symptoms and radiological abnormalities occurred spontaneously after discontinuation of mesalazine.From January 1994 to September 2015,9 cases of mesalazine-induced eosinophilic pneumonia were reported.Among all 10 patients,there were 3 males and 7 females,ranging from 23 to 56 years old,and the average age was 34.5 years old.Non-productive cough and fever were the common symptoms,and computed tomography scan usually revealed pulmonary infiltrates in both lungs.Blood test and bronchoalveolar lavage showed an increased eosinophil count.Lung function tests usually demonstrated restrictive ventilator dysfunction and decreased DLCO.Cessation of mesalazine resulted in a complete resolution of the symptoms and radiologic abnormalities.Conclusions Mesalazine-induced eosinophilic pneumonia is an extremely rare entity.Clinical and imaging manifestations are not specific.The diagnosis is relied on history of mesalazine therapy,eosinophilia in blood,pulmonary histiocytic infiltration with eosinophils and markedly improvement of symptoms and radiologic abnormalities after the discontinuation of mesalazine.The possibility of drug-induced eosinophilic pneumonia should be fully considered in patients developing unexplained respiratory symptoms while on mesalazine therapy.