A Case of Clarithromycin-induced Eosinophilic Pneumonia and Myocarditis
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Tarih
2015
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Abstract: Akut eozinofilik pnömoni, solunum yetmezliği, radyolojik infiltrasyonlar ve akciğerlerin eozinofil infiltrasyonu ile karakterize, etiyolojisi çoğunlukla bilinmeyen nadir bir hastalıktır. Klaritromisin, yaygın kullanılan, iyi tolere edilen ve yan etkileri nadir bir antibiyotiktir. Astım tanısı bulunan 31 yaşında erkek hasta, nefes darlığı, öksürük, balgam ve ateş şikâyetleri ile başvurdu. Klaritromisin kullanmasına rağmen şikâyetlerinin artması üzerine, astım ve pnömoni tanısıyla yatırıldı. Lökosit: 23.400/ml(eozonifil: %8) idi. Ampisilin-sülbaktam+klaritromisin başlandı. Lökosit ve ateş yüksekliği devam etmesi üzerine mevcut antibiyotikler kesilip cefepim, teiokoplanin ve ciprofloxacin başlandı. Takiplerimizde göğüs ağrısının gelişmesi ve solunum sıkıntısı artması üzerine yapılan kardiyolojik değerlendirmede akut myokardit teşhisi kondu. Bilgisayarlı tomografide bilateral plevral efüzyon ve pnömonik infiltrasyon izlendi. Alınan kan, balgam ve trakeal aspiratlarında bakteri üremedi. Gaitada parazit görülmedi. Lökosit ve eozinofilin artması üzerine hasta eozinofilik pnömoni olarak değerlendirildi. Metilprednizolon başlanmasında sonra çok hızlı klinik, laboratuar ve radyolojik düzelme görüldü. Sunulan olgu tedaviye cevap vermeyen pnömonili bir hastada ayırıcı tanıda eozinofilik pnömoninin düşünülmesi gerektiğini göstermektedir.
Abstract: Acute eosinophilic pneumonia (AEP) is a rare disease with unknown etiology that is characterised by pulmonary infiltration in radiography and eosinophilic infiltration into the lungs. Clarithromycin is a commonly used and well tolerated antibiotic. A 31-year-old male asthma patient was admitted with dyspnea, fever, and sputum. Despite the clarithromycin treatment the patient s complaints worsened. Leukocytes was 23400/ml (eosinophil 8%). We re-applied ampicillin-sulbactam and clarithromycin. Since leukocytosis and fever were persisting, antibiotics were withdrawn and cefepim, teicoplanin, and ciprofloxacin were started. Because the patient developed chest pain and his dyspnea worsened, we diagnosed the patient with myocardititis after the cardiac evaluation. The tomography showed pleural effusion and consolidation. Sputum, blood, and tracheal aspirates showed no microorganism production. No parasites were found in feces, either. Leukocyte and eosinophil levels got worsened. The patient was then diagnosed with eosinophilic pneumonia. After methylprednisolon was administrated, laboratory, radiological, and clinical findings improved. This case suggests that eosinophilic pneumonia should be considered in the differential diagnosis of patients with pneumonia who do not respond to treatment.
Abstract: Acute eosinophilic pneumonia (AEP) is a rare disease with unknown etiology that is characterised by pulmonary infiltration in radiography and eosinophilic infiltration into the lungs. Clarithromycin is a commonly used and well tolerated antibiotic. A 31-year-old male asthma patient was admitted with dyspnea, fever, and sputum. Despite the clarithromycin treatment the patient s complaints worsened. Leukocytes was 23400/ml (eosinophil 8%). We re-applied ampicillin-sulbactam and clarithromycin. Since leukocytosis and fever were persisting, antibiotics were withdrawn and cefepim, teicoplanin, and ciprofloxacin were started. Because the patient developed chest pain and his dyspnea worsened, we diagnosed the patient with myocardititis after the cardiac evaluation. The tomography showed pleural effusion and consolidation. Sputum, blood, and tracheal aspirates showed no microorganism production. No parasites were found in feces, either. Leukocyte and eosinophil levels got worsened. The patient was then diagnosed with eosinophilic pneumonia. After methylprednisolon was administrated, laboratory, radiological, and clinical findings improved. This case suggests that eosinophilic pneumonia should be considered in the differential diagnosis of patients with pneumonia who do not respond to treatment.
Açıklama
Anahtar Kelimeler
Kaynak
Turgut Özal Tıp Merkezi Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
22
Sayı
2
Künye
KILIÇ T,YILDIRIM Z,TOPAL E (2015). A Case of Clarithromycin-induced Eosinophilic Pneumonia and Myocarditis. İnönü Üniversitesi Turgut Özal Tıp Merkezi Dergisi, 22(2), 131 - 133.
