Clinical and CT characteristics of Chinese medicine-induced acute respiratory distress syndrome.
OBJECTIVE
The aim of the present study was to explore the clinical and radiographic characteristics of Chinese medicine-induced acute respiratory distress syndrome (ARDS), focusing on high resolution CT (HRCT) findings.


METHODS
Five patients diagnosed with Chinese medicine-induced ARDS were enrolled in the study. Details regarding clinical history, previous medical history, and laboratory data were collected and reviewed. The extent of involvement of each HRCT abnormality was assessed for each of three zones of each lung and was estimated to the nearest 10% of parenchymal involvement.


RESULTS
The causative Chinese medicines were as follows: Sho-saiko-to (two cases), Sai-rei-to (two cases) and Otsu-ji-to (one case). Scutellariae radix was the common ingredient in these drugs. The mean duration of medication use before the onset of ARDS was 22 days (range 7-49 days). High levels of C-reactive protein and lactate dehydrogenase (LDH), and mild liver dysfunction were common laboratory findings. The major HRCT findings were as follows: ground-glass opacity 50.2% (range 37-68%); airspace consolidation 16.0% (7-27%); spared area 26.6% (7-45%). In addition, the abnormalities tended to predominate in the peribronchovascular regions. Furthermore, architectural distortion was seen in all five cases, interlobular septal thickening occurred in four, irregular interface in four, and interlobar effusion in two. Corticosteroid therapy was very effective, and partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FIO2) improved in proportion to the decrease in LDH level.


CONCLUSIONS
Patients with Chinese medicine-induced acute lung injury exhibited ARDS. However, their prognosis was satisfactory, which suggests that a hypersensitivity reaction or a permeability oedema with minimal epithelial injury may be involved in the pathophysiology.
Sakamoto
Osamu
O
First Department of Internal Medicine, Kumamoto University School of Medicine, Kumamoto, Japan. osamu@kaiju.medic.kumamoto-u.ac.jp
Ichikado
Kazuya
K
Kohrogi
Hirotsugu
H
Suga
Moritaka
M
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D004365:Drugs, Chinese Herbal / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000139:chemically induced / Q000000981:diagnostic imaging* / Q000188:drug therapy; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D004365:Drugs, Chinese Herbal; D007770:L-Lactate Dehydrogenase