Pneumonitis with Diffuse Alveolar Hemorrhage Induced by Sho-seiryu-to

Abstract

A 78-year-old man presented with acute-onset fever and dyspnea. He had been taking Sho-seiryu-to for allergic rhinitis. A chest radiograph showed diffuse bilateral ground-glass opacities with subpleural sparing, crazy-paving pattern, and traction bronchiectasis. The patient's bronchoalveolar lavage fluid was bloody and transbronchial lung biopsy specimens showed alveolitis, organizing pneumonia, and type 2 alveolar epithelial cell proliferation. There were no clinical and laboratory findings suggestive of respiratory tract infection or connective tissue disease. Based on the clinical course and the exclusion of other etiologies, Sho-seiryu-to-induced pneumonitis with diffuse alveolar hemorrhage was considered. The patient's pneumonitis resolved after the discontinuation of the drug and the administration of systemic corticosteroid therapy.

Keywords: Sho-seiryu-to; Xiao-Qing-Long-Tang; diffuse alveolar hemorrhage; drug induced pneumonitis; herbal medicine.

Figure 1.

A chest radiograph showing diffuse bilateral ground-glass opacities (A). High-resolution computed tomography of the chest confirms the presence of diffuse ground-glass opacities with subpleural sparing, interlobular septal thickening, a crazy-paving appearance and traction bronchiectasis (B, C). Small amounts of pleural effusion and emphysema are also seen on both upper lobes.

Figure 2.

The gross appearance of the bronchoalveolar lavage fluid was bloody.

Figure 3.

A transbronchial lung biopsy specimen shows alveolitis; organizing pneumonia (asterisk); proliferation of type 2 alveolar epithelial cells (arrow) (Hematoxylin and Eosin staining, ×200).