A case of sho-saiko-to-induced pneumonitis, diagnosed by lymphocyte stimulation test using bronchoalveolar lavage fluid

Abstract

A 66-year-old Japanese man was admitted to our hospital with fever, cough and dyspnea. He had been taking Sho-Saiko-to, a traditional Chinese medicine, for twenty days. On admission, chest X-ray examination revealed a reticular pattern in the bilateral lungs, and respiratory failure was evident. Serum levels of CRP and LDH were elevated. A differential cell count of the bronchoalveolar lavage fluid (BALF) showed that lymphocytes and eosinophils were increased. Alveolitis with lymphocyte and plasma cell infiltration was observed in a pathological specimen obtained by transbronchial lung biopsy. After all drugs had been discontinued, PaO2, serum CRP and serum LDH improved, and the reticular pattern in the bilateral lungs gradually resolved without administration of corticosteroids or antibiotics. A lymphocyte stimulation test for Sho-Saiko-to using BALF gave a positive result, although LST using blood gave a doubtful reaction. The diagnosis of Sho-Saiko-to-induced pneumonitis was made from the clinical course, laboratory findings, BALF cell analysis, pathological findings and LST using BALF. Only 13 cases of pneumonitis due to administration of traditional Chinese medical drugs have been reported. This case suggests that LST using BALF is useful for the diagnosis of drug-induced pneumonitis.