[Pulmonary infiltration with eosinophilia possibly induced by cefotiam in a case of steroid-dependent asthma].
A 37-year-old female with refractory asthma taking betamethasone orally (1 mg/d), showed a fever of 38.5 degrees C, productive cough and dyspnea. The chest X-ray demonstrated diffuse infiltration in the left lower lung field. The WBC count was 16,000/mm3 with 6% eosinophils. She was treated with intravenous drip infusion of antibiotics (Cefotiam 2 mg/d and Sisomicin 150 mg/d) for 2 weeks, and her symptoms and the chest X-ray findings improved. However, at the end of the therapy eosinophilia was noticed. Sixteen days after the completion of antibiotic therapy, she again experienced fever, cough and dyspnea. The chest X-ray again demonstrated diffuse infiltrations in the left lower lung field. The total IgE level, histamine and circulating immune complex titers were elevated. The WBC count was 14,700/mm3 with 34% eosinophils. Although a sputum culture yielded no organisms, many eosinophils were observed in the sputum. There were no clinical or laboratory findings compatible with allergic broncho-pulmonary aspergillosis. After the administration of oral prednisolone (40 mg/d), the patient showed rapid improvement with resolution of all symptoms and normalization of the IgE, histamine and circulating immune complex levels. The chest X-ray revealed marked regression of the pulmonary infiltrations. A microscopic examination of a transbronchial biopsy specimen demonstrated moderate eosinophilic infiltrations. It was compatible with the diagnosis of pulmonary infiltration with eosinophilia. Treatment was performed with prednisolone. The result of a lymphocyte stimulation test was positive for Cefotiam. An in vitro test was performed to evaluate the diagnosis of drug allergy in this case.(ABSTRACT TRUNCATED AT 250 WORDS)
Irie
M
M
Department of Psychosomatic Medicine, Kyushu University School of Medicine, Fukuoka.
Teshima
H
H
Matsuura
T
T
Sogawa
H
H
Kihara
H
H
Kubo
C
C
Nakagawa
T
T
D000328:Adult; D000936:Antigen-Antibody Complex / Q000032:analysis; D001249:Asthma / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D001623:Betamethasone / Q000008:administration & dosage; D015310:Cefotiam / Q000009:adverse effects* / Q000276:immunology; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000032:analysis; D011014:Pneumonia / Q000150:complications / Q000188:drug therapy; D011239:Prednisolone / Q000008:administration & dosage; D011657:Pulmonary Eosinophilia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D012008:Recurrence
D000936:Antigen-Antibody Complex; D007073:Immunoglobulin E; D015310:Cefotiam; D001623:Betamethasone; D011239:Prednisolone