Herbal Medicine-Induced Lung Injury Presenting as Acute Respiratory Distress Syndrome

藥物會導致肺傷害，越來越多的報告顯示，藥物引致肺部不良反應是急慢性肺疾患的原因。我們報告一例中藥引致肺傷害而導致急性呼吸窘迫徵候群。一位41歲男性在住院前兩週開始有乾咳及發燒的症狀，幾天之後發生全身肌肉酸痛及腹瀉的現象。根據臨床資料，病人被診斷為非典型肺炎而接受治療。未久，病人很快進展急性呼吸窘迫症候群。因為導致急性呼吸窘迫症候群的病因不明，病人接受支氣管肺泡灌洗術。支氣管肺泡灌洗液的細胞學檢查發現，許多肺泡吞噬細胞呈現泡沫狀細胞，且對蘇丹黑染色呈現陽性反應。在高度懷疑藥物引致性肺損傷，給予脈衝類固醇治療後，肺部病灶快速改善，病人順利出院。詳細詢問病人過去病史，病人所服用的中藥可能是造成此次生病的主要原因。本案例警示中藥的成分複雜，可能會引致肺傷害或導致急性呼吸窘迫症候群，支氣管灌肺泡洗術對於藥物引致性肺傷害之診斷有其臨床效益。（胸腔醫學 2012；27：94－99）

關鍵字

中藥；藥物引致肺部損傷；急性呼吸窘迫症候群

並列摘要

Drug use may lead to serious adverse effects in the lungs, and pulmonary drug toxicity is increasingly being diagnosed as a cause of acute and chronic lung diseases. We reported a case of herbal medicine-induced lung injury presenting as acute respiratory distress syndrome (ARDS).A 41-year-old male suffered from dry cough with intermittent fever and chills for 2 weeks prior to this admission; generalized muscle pain and mild diarrhea developed a few days later. The patient was treated for atypical pneumonia. Unfortunately, ARDS developed despite the use of moxifloxacin and Tamiflu. Diagnostic bronchoalveolar lavage (BAL) was performed, and the majority of alveolar macrophages in the BAL fluid had a foamy appearance and showed positive for Sudan black stain. Sudan black stain is used to detect pulmonary phospholipidosis. Drug-induced lung injury was highly suspected, and the patient then underwent pulse therapy with methylprednisolone. The lung lesions improved dramatically and the patient was discharged with maintenance oral steroid.This case highlights the realization that herbal medicine, with its complex compositions, should be considered to be a cause of drug-induced lung injury. BAL may be of value in aiding the diagnosis of drug-induced lung injury as suggested by pulmonary phospholipidosis. (Thorac Med 2012; 27: 94-99)

並列關鍵字

herbal medicines ； drug-induced lung injury ； acute respiratory distress syndrome ； phospholipidosis

國際替代計量

Herbal Medicine-Induced Lung Injury Presenting as Acute Respiratory Distress Syndrome

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