title: Severe drug-induced interstitial lung disease successfully treated with corticosteroid plus recombinant human soluble thrombomodulin.
abstract: There is no established therapeutic option for corticosteroid (CS) refractory drug-induced interstitial lung disease (DILD). We report a case of CS refractory severe DILD successfully treated with recombinant human soluble thrombomodulin (rhTM). A 64-year-old Japanese man was admitted with symptoms of fever, dry cough and dyspnoea. A chest radiograph showed bilateral infiltrations. DILD from Nijutsutou, a Chinese medicine, was suspected based on a history of similar interstitial lung disease after its administration 4 years prior and a positive drug-induced lymphocyte stimulation test. Nijutsutou was promptly discontinued and high doses of CS administered, but the patient's bilateral infiltrations remained unimproved. Since coagulation tests also indicated a rapid aggravation of coagulopathy, rhTM was added to the CS therapy. The patient's lung infiltration ameliorated and plasma levels of D-dimer and high morbidity group box 1 (HMGB1) decreased. rhTM may be an alternative agent for CS refractory DILD. Further study is necessary to confirm this.
authors.affiliation: Respiratory Disease Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Marumo
authors.affiliation: Respiratory Disease Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Shirata
authors.affiliation: Respiratory Disease Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Sakuramoto
authors.affiliation: Respiratory Disease Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.
authors.forename: Motonari
authors.initials: M
authors.lastname: Fukui
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000188:drug therapy; D004359:Drug Therapy, Combination; D004365:Drugs, Chinese Herbal / Q000009:adverse effects; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D024243:HMGB1 Protein / Q000097:blood; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000139:chemically induced / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D018180:Thrombomodulin / Q000627:therapeutic use*
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D004365:Drugs, Chinese Herbal; D005338:Fibrin Fibrinogen Degradation Products; D024243:HMGB1 Protein; C585491:HMGB1 protein, human; C546931:THBD protein, human; D018180:Thrombomodulin; C036309:fibrin fragment D