PDF(Pubmed)
Abstract：
Amikacin liposome inhalation suspension (ALIS) is a key drug for the treatment of refractory Mycobacterium avium complex pulmonary disease (MAC-PD). Although cases of drug-induced interstitial lung disease (DIILD) by ALIS have been reported, its diagnosis is challenging due to overlapping existing pulmonary shadows, airway bleeding, exacerbation of underlying conditions, and the potential for various concurrent infections. A 72-year-old woman started treatment with ALIS for refractory MAC-PD. Three weeks later, she had a fever, cough, and appetite loss. She was hospitalized because multiple infiltrative opacities were observed on chest X-ray and chest computed tomography. Because the opacities worsened after empiric antibiotic therapy with broad-spectrum antibiotics, we initiated corticosteroid therapy, suspecting DIILD caused by ALIS, although drug lymphocyte stimulation tests for ALIS and amikacin were negative. Three days later, we found signs of improvement and quickly tapered the corticosteroids. After obtaining informed consent, we performed a drug provocation test of ALIS. Seven days later, she exhibited fever, an increased peripheral white blood cell count, and elevated serum C-reactive protein level, all of which returned to baseline 4 days after stopping ALIS, leading to a diagnosis of DIILD caused by ALIS in this patient. DIILD caused by ALIS is rare but should be carefully diagnosed to ensure that patients with refractory MAC-PD do not miss the opportunity to receive ALIS treatment.
摘要：
阿米卡星脂质体吸入混悬液（ALIS）是治疗难治性鸟分枝杆菌复杂性肺病（MAC-PD）的关键药物。尽管已经报道了ALIS引起的药物引起的间质性肺病（DIILD）的病例，由于现有的肺部阴影重叠，其诊断具有挑战性，气道出血,潜在条件的恶化，以及各种并发感染的可能性。一名72岁的女性开始使用ALIS治疗难治性MAC-PD。三周后,她发烧了,咳嗽,和食欲减退。她住院是因为在胸部X射线和胸部计算机断层扫描中观察到多个浸润性混浊。因为使用广谱抗生素进行经验性抗生素治疗后混浊恶化，我们开始了皮质类固醇治疗,怀疑是由ALIS造成的，尽管ALIS和阿米卡星的药物淋巴细胞刺激试验均为阴性。三天后,我们发现了改善的迹象，并迅速减少了皮质类固醇。在获得知情同意后，我们进行了ALIS的药物激发试验.七天后,她表现出发烧，外周血白细胞计数增加,血清C反应蛋白水平升高,所有这些都在停止ALIS后4天恢复到基线，导致该患者诊断为由ALIS引起的DIILD。由ALIS引起的DIILD很少见，但应仔细诊断，以确保难治性MAC-PD患者不会错过接受ALIS治疗的机会。
