title: [A case of steroid-resistant acute hypersensitivity pneumonitis successfully treated with an immunosuppressive drug].
abstract: A 28-year-old man complaining of cough and fever was hospitalized because of bilateral diffuse granular lung shadows. Hypersensitivity pneumonitis was diagnosed based on bronchoalveolar lavage fluid (BALF) and transbronchial lung biopsy (TBLB). Since antigen avoidance alone was not effective, steroid pulse therapy was started, and his symptoms and chest X-ray findings improved. After discharge, he moved to another residence. A few weeks later, fever and dyspnea recurred, then he was hospitalized on the suspicion of acute exacerbation of hypersensitivity pneumonitis. Steroid therapy resulted in no improvement on this occasion. Lung biopsy under video-assisted thoracoscopy was performed, and acute hypersensitivity pneumonitis was diagnosed pathologically. Although steroid therapy was continued, hypoxia still remained and a KL-6 level markedly increased. Combined therapy with steroid and cyclosporin A was started, and his symptoms, physical findings, laboratory data, and chest X-ray findings gradually improved. There has been no report in which cyclosporin A was used for acute hypersensitivity pneumonitis but this case indicates that cyclosporin A is efficacious for its treatment.
authors.affiliation: Department of Respiratory Medicine, Kanto Central Hospital.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kawakami
authors.forename: Masaru
authors.initials: M
authors.lastname: Suzuki
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Hirota
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Kichikawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kitagawa
authors.forename: Makoto
authors.initials: M
authors.lastname: Kawai
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tashimo
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Teruaki
authors.initials: T
authors.lastname: Oka
authors.forename: Tadashi
authors.initials: T
authors.lastname: Horiuchi
mesh_terms: D000328:Adult; D000542:Alveolitis, Extrinsic Allergic / Q000188:drug therapy* / Q000473:pathology; D016572:Cyclosporine / Q000627:therapeutic use*; D004351:Drug Resistance; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008775:Methylprednisolone / Q000494:pharmacology; D011239:Prednisolone / Q000494:pharmacology
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011239:Prednisolone; D008775:Methylprednisolone