title: Epoprostenol-associated pneumonitis: diagnostic use of a T-cell proliferation assay.
abstract: We describe a case of severe drug-induced interstitial pneumonitis in a woman with idiopathic pulmonary arterial hypertension receiving epoprostenol confirmed by a drug T-cell proliferation assay. Proliferation assays were completed in our patient and in a healthy control. Isolated T cells were incubated with CD3-depleted peripheral blood mononuclear cells and then stimulated to proliferate with (3)H-thymidine in the presence of epoprostenol, other prostanoid analogs, and controls. A significant (p < 0.001) T-cell proliferation response occurred in our patient in the presence of epoprostenol alone. There was a trend towards an increased T-cell response to treprostinil but this was statistically insignificant. There was no significant T-cell response to the diluent alone, normal saline, iloprost, or alprostadil. There was no significant proliferation to any drug in the healthy control. Hence, a drug T-cell proliferation assay confirmed that epoprostenol can rarely incite a profound inflammatory response in the pulmonary interstitium.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, California, USA. kkudelko@stanford.edu
authors.forename: Kristina T
authors.initials: KT
authors.lastname: Kudelko
authors.forename: Kari
authors.initials: K
authors.lastname: Nadeau
authors.forename: Ann N
authors.initials: AN
authors.lastname: Leung
authors.forename: Juliana
authors.initials: J
authors.lastname: Liu
authors.forename: François
authors.initials: F
authors.lastname: Haddad
authors.forename: Roham T
authors.initials: RT
authors.lastname: Zamanian
authors.forename: Vinicio
authors.initials: V
authors.lastname: De Jesus Perez
mesh_terms: D000328:Adult; D000638:Amiodarone / Q000009:adverse effects* / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000009:adverse effects*; D004347:Drug Interactions; D011464:Epoprostenol / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging; D008171:Lung Diseases / Q000139:chemically induced*; D008213:Lymphocyte Activation; D011014:Pneumonia / Q000139:chemically induced*; D011241:Prednisone / Q000627:therapeutic use; D013601:T-Lymphocytes / Q000276:immunology*; D014463:Ultrasonography
chemical_list: D000889:Anti-Arrhythmia Agents; D000959:Antihypertensive Agents; D011464:Epoprostenol; D000638:Amiodarone; D011241:Prednisone