Pulmonary infiltration with eosinophilia (PIE) syndrome induced by antibiotics, PIPC and TFLX during cancer treatment.
Pulmonary infiltration with eosinophilia (PIE) syndrome induced by antibiotics, PIPC and TFLX during cancer treatment.
复制标题
癌症治疗期间抗生素、PIPC 和 TFLX 诱导的肺浸润伴嗜酸性粒细胞增多 (PIE) 综合征。
DOI：
10.1016/s1368-8375(00)00108-1
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发表时间：
2001
期刊：
影响因子：
4.8
通讯作者：
T. Osaki
中科院分区：
文献类型：
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作者：
Tetsuya Yamamoto;T. Tanida;E. Ueta;Tsuyoshi Kimura;S. Doi;T. Osaki
药物可导致多种肺部疾病，包括嗜酸性粒细胞增多症(PIE)综合征。我们报告一例颈淋巴清扫术后观察到的派综合征。一位83岁男性患者于本院就诊，主诉上颈部肿大，被诊断为与先前切除的口腔癌相关的晚期淋巴结转移，并行颈淋巴清扫术。尽管使用了抗生素(哌拉西林钠，PIPC和托氟沙星，TFLX)，中性粒细胞增多时仍出现发热和C反应蛋白(CRP)水平升高，并在右下肺野观察到浸润性阴影。由于怀疑患有肺炎，抗生素被换成了帕尼培南/倍他米隆。换用抗生素后数天，C反应蛋白升高至12.9 mg/dl，并出现严重嗜酸性粒细胞增多(23%)。患者被怀疑为PIE综合征，并接受了由甲基强的松龙琥珀酸钠(500 Mg)和强的松龙(60 Mg)组成的类固醇微脉冲治疗。经过类固醇治疗后，肺部情况有了很大改善。但在开始使用类固醇后约2周，出现发热，C反应蛋白进一步升高，血清β-d-葡聚糖升高。X线片显示肺内弥漫性浸润性阴影，患者因呼吸窘迫起病约3周后死亡。在体外，PIPC和TFLX能强烈促进患者外周血淋巴细胞的分化，并在PIPC或TFLX存在的情况下产生大量的IL-5。临床病程和实验室检查结果表明，PIE综合征可能是由PIPC和TFLX诱发的，在肿瘤的治疗中，当呼吸困难和肺浸润合并嗜酸性粒细胞增多时，应怀疑PIE综合征。
Drugs induce a variety of pulmonary diseases including pulmonary infiltration with eosinophilia (PIE) syndrome. We report a case of PIE syndrome which was observed after neck dissection. An 83-year-old male patient attended our clinic complaining of upper neck swelling and was diagnosed as advanced lymph node metastasis related to previously resected oral carcinoma and underwent neck dissection. Despite administration of antibiotics (piperacillin sodium, PIPC; and tosufloxacin tosilate, TFLX), fever and an elevation of the c-reactive protein (CRP) level with neutrophilia appeared, and an infiltration shadow was observed in the right lower pulmonary field. With the suspicion of pneumonia, the antibiotics were exchanged for panipenem/betamipron. However, the pulmonary infiltration spread widely, CRP increased to 12.9 mg/dl and severe eosinophilia (23%) was observed a few days after changing the antibiotics. PIE syndrome was suspected, and the patient underwent steroid mini-pulse therapy consisting of methylprednisolone sodium succinate (500 mg) and prednisolone (60 mg). After steroid therapy, the pulmonary condition largely improved. However, about 2 weeks after the start of steroid administration, a fever and a further elevation of CRP were observed with an increase of β-d-glucan in serum. Roentgenography revealed diffuse infiltration shadows throughout the lungs, and the patient died about 3 weeks after the onset from respiratory distress. In vitro, blastogenesis of patient's peripheral blood lymphocytes was strongly enhanced by PIPC and TFLX, and they generated a large amount of interleukin-5 in the presence of PIPC or TFLX. The clinical course and laboratory examination results revealed that PIE syndrome may have been induced by PIPC and TFLX and that PIE syndrome should be suspected in treatment of carcinomas when dyspnea and pulmonary infiltration are complicated with eosinophilia.
“重要技术主题 1”《日经科技前沿》19-21 (1997)。
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