干扰素致间质性肺炎合并多发性神经损伤案例分析

The case analysis of lung injury and multiple nerve damage caused by interferon

1例54岁女性患者,因发现血小板增多症使用干扰素近40 d。约1个月后患者出现高热,体温最高40℃,咳嗽剧烈,伴咯粉红色黏痰,上午较重,伴前臂疼痛,周身不适,肢体感觉异常,到当地医院就诊考虑呼吸道感染,给予抗感染、抗病毒、止咳化痰等对症处理后,症状稍有改善,但出院后仍有低热、咳嗽。之后再次就诊于当地医院,行肺部CT提示:双肺散在多发斑片状高密度影,边缘模糊。给予抗炎、祛痰及对症治疗,住院期间体温正常,咳嗽咳痰症状减轻。患者自觉乏力,体质量下降10 kg,后就诊于我院呼吸科门诊,给予左氧氟沙星抗感染治疗10 d,患者咳嗽减轻,为进一步检查及治疗入院。入院后考虑为干扰素导致的药源性肺损伤及神经损伤,给予泼尼松治疗3 d后,患者乏力、指端麻木感减轻;8 d后患者无乏力,指端麻木感明显减轻,复查胸部影像较之前吸收明显,患者出院。

A 54-year-old female patient took interferon for 40 days due to suffering from thrombocytosis.About one month later,the patient had a high fever with 40 ℃,and severe cough accompanied by pink sticky sputum which was serious in the morning.The patient also felt forearm pain,malaise and abnormal limb sensation.The clinical diagnosis was respiratory tract infection.After symptomatic treatment,such as anti-infection,antivirus,cough relieving and expectorang,the symptoms slightly improved,after discharged,but there were still low fever and cough.Then the patient was admitted and her pulmonary CT showed double lung scattered in multiple patchy high density shadows with blurred edges.After receiving anti-inflammatory,expectorant and symptomatic treatment,the patient’s temperature was normal and cough improved.Then the patient visited respiratory outpatient and was administered with levofl oxacin 10 days,meanwhile the cough improved and hemoptysis disappeared.The patient reported a loss of 10 kg in weight and she was readmitted to respiration department in our hospital for further examination and treatment.The patient was considered for drug-induced lung injury and nerve damage,meanwhile,she was treated with prednisone for 3 days,and then the weakness and numbness of the fi ngers were relieved.After 8 days,these symptoms were relieved obviously.Chest images showed pulmonary infl ammations were signifi cantly absorbed than before,then the patient was discharged.