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Báo cáo y học: "Amoxicillin-Induced Eosinophilic Pneumonia with Granulomatous Reaction: Discrepancy between DrugInduced Lymphocyte"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: Amoxicillin-Induced Eosinophilic Pneumonia with Granulomatous Reaction: Discrepancy between DrugInduced Lymphocyte . | CASE REPORT Amoxicillin-Induced Eosinophilic Pneumonia with Granulomatous Reaction Discrepancy between Drug-Induced Lymphocyte Stimulation Test Findings and the Provocation Drug Test Osamu Matsuno MD Ryuichi Takenaka MD Masaru Ando MD Eishi Miyazaki MD and Tosihide Kumamoto MD A 59-year-old man was admitted to the hospital with pulmonary infiltration fever erythema and eosinophilia. Two weeks before admission he received amoxicillin acetaminophen and shoseiryu-to a Japanese herbal medicine for a common cold. Bronchoalveolar lavage was performed and an increased number of eosinophils was recovered. Transbronchial biopsy specimens showed granuloma and interstitial thickening with eosinophils and lymphocytes. Drug-induced eosinophilic pneumonia was suspected so all drugs were discontinued. The symptoms and infiltration shadow disappeared. A drug-induced lymphocyte stimulation test DLST was positive for acetaminophen but not for amoxicillin. In contrast to the DLST a provocation test revealed that amoxicillin induced the drug allergy. A very striking observation was the coexistence of pulmonary eosinophilia and granulomatous lung infiltrations. In addition there was a discrepancy between the DLST and provocation test findings. To our knowledge there is no previous report of drug-induced eosinophilic pneumonia with a granulomatous reaction. Key words amoxicillin drug-induced lymphocyte stimulation test drug-induced pneumonia granuloma provocation test Allergic reactions to b-lactam drugs especially penicillin are commonly reported. The most common b-lactam-induced drug reactions are maculopapular or morbilliform and urticarial eruption.1 Drug-induced pneumonia however is relatively rare.2-5 There are only a few reports of the clinical manifestations of penicillin-induced eosinophilic pneumonia.6 7 A drug-induced lymphocyte stimulation test DLST measures the proliferation of T cells in response to a drug in vitro. DLST is rather useful for diagnosing patients with drug .