The medicines which are most often causing development of a pulmonary eosinophilic infiltration: • nitrofurantoin (most often); • streptocides; • penicillin; • Chlorproramidum; • thiazide diuretics; • tricyclic antidepressants; • gidralazin; • isoniazid; • p-aminosalicylic acid; • kromoglitsiyevy acid (seldom), etc. The pathogeny of formation of eosinophilic infiltrates is a little studied. It is known that nitrofurans promote education autoanitet to albumine with the subsequent immune complex deposition in lungs.
Clinical signs and symptoms of an illness
Clinical manifestations arise on average in 2 hours — 10 days after the beginning of reception of medicines and are characterized by the following symptoms: • dry cough; • thorax pain; • asthma; • fervescence with a fever; • arterial hypotonia; • small tortoiseshell; • arthralgias.
The diagnosis and the recommended clinical trials
In clinical blood test reveal increase of level of eosinophils. In a phlegm, bronchoalveolar lavazhny liquid, a pleural exudate (at a puncture) — a large number of eosinophils. At a X-ray analysis of lungs reveal focal shadows (most often bilateral) or limited blackout of pulmonary fields, sometimes a pleural exudate. "Volatility" is characteristic of eosinophilic infiltrates: for several days the X-ray pattern can significantly change.
It is necessary to carry out differential diagnosis with pneumonia, system vasculites with damage of lungs, a parasitic invasion of lungs, paraneoplastic process. Unlike all these diseases at RODS positive clinicoradiological dynamics (3 — 4 days) after cancellation of medicine and purpose of short course GKS is observed fast.
Principles of treatment of a pulmonary eosinophilic infiltration
Easy current Prednisolonum in 15 mg/days; in/in 90 — 120 mg/days (before stopping of symptoms) Medium-weight current Before stopping of symptoms: Prednisolonum in 30 mg/days + Prednisolonum in/in 90 — 120 mg/days
After achievement of clinical effect: Prednisolonum in 15 mg/days of 10 days Heavy current Before stopping of symptoms: Prednisolonum in 1 mg/kg + Prednisolonum in/in 300 mg/days After achievement of clinical effect: Prednisolonum in 1 mg/kg with a dose decline on 5 mg/week before full cancellation
Assessment of efficiency of treatment
Criterion of efficiency of treatment is disappearance of clinical manifestations and radiological changes.