リポソーム化ドキソルビシン投与後に問質性肺炎で死亡した一例

摘要

化学療法後に発生した問質性肺炎の鑑別診断は，日和見感染症，薬剤性肺炎等の可能性が考慮され，臨床的には難題である．今回我々はリポソーム化ドキソルビシン（以下ドキシル）による化学療法後に発症した問質性肺炎による死亡例を報告する．患者は68歳の卵巣癌患者の女性で，カルボプラチン，バクリタキセル，ドセタキセル，イリノテカンにすでに不応となったため，ドキシル単剤（40mg／m~2）を4～5週毎に投与した．5回目投与の1カ月後突然呼吸困難が出現し，CTおよび血液検査等で問質性肺炎と診断されたが，その原因は不明であった．その後ステロイドパルス療法や抗生物質投与を施行したが，約1週間で永眠された．剖検では肺胞上皮の一部に巨細胞核内封入体を認め，サイトメガロウイルス肺炎を示唆する像を呈していねが，非特異性問質性肺炎の像も認められ，薬剤性肺炎の可能性も完全に否定はできない所見であった．%Differential diagnosis for interstitial pneumonia after chemotherapy is a challenge because it may be due to opportunistic infection of various microorganisms, drug-induced pneumonia and so on. In this report, we describe a fatal case of interstitial pneumonia after chemotherapy.rnA 68-year-old female with ovarian cancer which had already been refractory to carboplatin, paclitaxel, docetaxel and irinotecan received liposomal doxorubicin (40mg/ m~2) therapy with 4 or 5 weeks interval. She developed sudden respiratory distress one month after the fifth dose of liposomal doxorubicin. Computed tomography scan and laboratory data showed severe interstitial pneumonia though its cause was not specified. One week later she died despite of methylprednisolone pulse therapy and large spectrum antimicrobial therapy. Her autopsy showed some inclusion bodies in alveolar epithelium suggesting cytomegalovirus infection, although the finding of unspecified interstitial pneumonia did not completely deny the possibility of drug-induced pneumonia.