[A case of steroid-resistant acute hypersensitivity pneumonitis successfully treated with an immunosuppressive drug].
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.
Kawakami
Masaki
M
Department of Respiratory Medicine, Kanto Central Hospital.
Suzuki
Masaru
M
Hirota
Nobuaki
N
Kichikawa
Yoshiko
Y
Kitagawa
Hiroshi
H
Kawai
Makoto
M
Tashimo
Hiroyuki
H
Sakamoto
Yoshio
Y
Oka
Teruaki
T
Horiuchi
Tadashi
T
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
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011239:Prednisolone; D008775:Methylprednisolone