Clarithromycin and pulmonary infiltration with eosinophilia

Diagnosis and Management of Drug-Induced Interstitial Lung Disease Associated with Amikacin Liposome Inhalation Suspension in Refractory Mycobacterium Avium Complex Pulmonary Disease: A Case Report

Amikacin liposome inhalation suspension (ALIS) is a key drug for the treatment of refractory Mycobacterium avium complex pulmonary disease (MAC-PD). Although cases of drug-induced interstitial lung disease (DIILD) by ALIS have been reported, its diagnosis is challenging due to overlapping existing pulmonary shadows, airway bleeding, exacerbation of underlying conditions, and the potential for various concurrent infections. A 72-year-old woman started treatment with ALIS for refractory MAC-PD. Three weeks later, she had a fever, cough, and appetite loss. She was hospitalized because multiple infiltrative opacities were observed on chest X-ray and chest computed tomography. Because the opacities worsened after empiric antibiotic therapy with broad-spectrum antibiotics, we initiated corticosteroid therapy, suspecting DIILD caused by ALIS, although drug lymphocyte stimulation tests for ALIS and amikacin were negative. Three days later, we found signs of improvement and quickly tapered the corticosteroids. After obtaining informed consent, we performed a drug provocation test of ALIS. Seven days later, she exhibited fever, an increased peripheral white blood cell count, and elevated serum C-reactive protein level, all of which returned to baseline 4 days after stopping ALIS, leading to a diagnosis of DIILD caused by ALIS in this patient. DIILD caused by ALIS is rare but should be carefully diagnosed to ensure that patients with refractory MAC-PD do not miss the opportunity to receive ALIS treatment.

Macrolide Allergic Reactions

Macrolides are antimicrobial agents that can be used to treat a variety of infections. Allergic reactions to macrolides occur infrequently but can include minor to severe cutaneous reactions as well as systemic life-threatening reactions such as anaphylaxis. Most reports of allergic reactions occurred in patients without prior exposure to a macrolide. Cross-reactivity among macrolides may occur due to the similarities in their chemical structures; however, some published literature indicates that some patients can tolerate a different macrolide. Most published reports detailed an allergic reaction to erythromycin. Desensitization protocols to clarithromycin and azithromycin have been described in the literature. The purpose of this article is to summarize macrolide-associated allergic reactions reported in published literature. An extensive literature search was conducted to identify publications linking macrolides to hypersensitivity reactions.

Acute Respiratory Distress Syndrome in a Patient with Acute Epstein-Barr Viral Infection and Eosinophilic Pneumonia

We report a case of acute respiratory distress syndrome associated with eosinophilic pneumonia in an adolescent with acute Epstein-Barr viral infection.

Clarithromycin-induced acute interstitial nephritis and minimal change disease

Drug associated acute interstitial nephritis and minimal change disease has been well documented but the simultaneous presentation of both is rare and has not been reported with clarithromycin. We describe a case of simultaneous acute tubulointerstitial nephritis and minimal change disease induced by clarithromycin. The patient had acute kidney injury, nephrotic syndrome, eosinophilic pneumonitis and a maculopapular skin rash. The role of steroid therapy in acute interstitial nephritis is controversial but is accepted as beneficial in minimal change nephrotic syndrome. Steroid therapy in our patient resulted in complete clinical resolution.

Eosinophilic interstitial lung disease

PURPOSE OF REVIEW

Although rare, the eosinophilic lung diseases are being increasingly identified as distinct clinical entities. These disorders are a heterogeneous group of disorders in which there is an increased number of eosinophils in the airways and/or lung parenchyma. These disease entities may be broadly separated into airway disorders (asthma, allergic bronchopulmonary mycosis, eosinophilic bronchitis, and bronchocentric granulomatosis) and parenchymal (interstitial) disorders. This review and update will concentrate on the latter group of entities.

RECENT FINDINGS

Recent publications in the field have concentrated on expanding the list of causative agents and clinical situations. An especially promising number of articles report advancements in the understanding of the pathogenetic mechanisms behind the development of the clinical syndromes.

SUMMARY

Whatever the function of the eosinophil in these disorders, it is important to remember that the disease processes lumped together as the eosinophilic lung diseases are a heterogeneous group of diseases. In an attempt to categorize these disorders, they have been connected, either appropriately or artificially, by their association with the eosinophil. Nevertheless, the eosinophilic connection may serve as a clue to pathogenesis and treatment.