[Two cases of pneumonitis caused by Seishinrenshiin, Chinese herbal medicine].

We report two cases of pneumonitis caused by Seishinrenshiin. A 54-year-old woman and a 80-year-old man had taken Seishinrenshiin for cystitis and benign prostatic hypertrophy. Their chest radiograph showed diffuse ground-glass shadows in the whole lung fields and chest CT showed diffuse ground-glass-opacities predominantly in the lower lung fields of both lungs. Biochemical tests revealed mild liver dysfunction and inflammatory reactions. Their abnormal chest shadows disappeared after discontinuation of Seishinrenshiin. We should be aware that Seishinrenshiin, as well as other Chinese herbal medicine, could be cause of drug-induced pneumonitis.

Mucosal vaccine using CTL epitope-pulsed dendritic cell confers protection for intracellular pathogen.

Effective protective immunity against respiratory infections with intracellular pathogens requires pathogen-specific cytotoxic T cells (CTL) in the lung. However, vaccines that induce pathogen-specific CTL in the lung are poorly explored. Dendritic cells (DC) have increasingly been exploited as vaccines against infections. However, few studies have investigated the ability of mucosal DC vaccines to elicit protective CTL responses in the lung. Our objective was to develop an efficacious mucosal DC vaccine to generate protective CTL against respiratory infections with intracellular pathogens. Bone marrow-derived DC (BM-DC) pulsed with a single immunodominant CTL epitope, listeriolysin O (LLO) 91-99, of Listeria monocytogenes (LM) were intratracheally administered into mice. The frequency and function of epitope-specific CTL in mediastinal lymph nodes (MLN) and spleen were assessed for their ability to protect against LM infection. After intratracheal administration, lipopolysaccharide (LPS)-treated LLO 91-99-loaded BM-DC (LPS-LLO DC) more frequently migrated to MLN than LPS-untreated LLO 91-99-loaded BM-DC (LLO DC). Using tetrameric H2-K(d)/LLO 91-99 peptide complex, specific CD8(+) T cells were found in MLN as well as the spleen in LPS-LLO DC-immunized mice, but not in LLO-DC-immunized mice. Both MLN and spleen cells obtained from LPS-LLO DC-immunized mice produced large amounts of IFN-gamma in response to LLO 91-99 with high epitope-specific CTL activities. Vaccination with LPS-LLO DC, but not LLO DC, protected mice against lethal respiratory infection with LM. These data suggest that mucosal vaccination with LPS-treated immunodominant CTL epitope-loaded DC is a promising strategy for generating protective CTL against respiratory infections with intracellular pathogens.

[A case of pneumonitis caused by Seisin-renshi-in, herbal medicine].

We report a case of pneumonitis induced by Seisin-renshi-in. A 62-year-old man began to complain of cough, dyspnea and fever 45 days after starting to take Seisin-renshi-in for benign prostate hypertrophy. Chest radiograph showed diffuse ground-glass shadows in the bilateral middle and lower lung fields. Chest CT showed diffuse ground-glass opacities in both lung fields. The serum KL-6 level was elevated. Arterial blood gas analysis revealed hypoxia. Lymphocyte stimulation test with peripheral blood lymphocytes for Seisin-renshi-in was positive. A mild increase of lymphocytes, neutrophils and eosinophils was observed in the cell population of bronchoalveolar lavage fluids. Transbronchial lung biopsy specimen showed lymphocytic infiltration into the alveolar septa, desquamative alveolar lining cells and fibrinous exudate in the alveolar spaces. On the basis of a diagnosis of Seisin-renshi-in-induced pneumonitis, steroid therapy was introduced. Three courses of steroid pulse therapy were required because of prolonged hypoxia. His respiratory condition then improved and predonisolone was tapered from 30 mg. We should be aware that over-the-counter drugs could be causal agents of severe pneumonitis.

[A case of severe intestinal tuberculosis, treated with ciprofloxacin, kanamycin and prednisolone].

A 31-year-old man was admitted to our hospital because of frequent diarrhea. Colonoscopy showed ring ulcers on the rectum and ascending colon and chest X-ray showed abnormal shadows which were diagnosed as tuberculosis by sputum PCR. He started treatment with isoniazid (INH), rifampicin (RFP), pyrazinamide (PZA) and streptomycin (SM), however, eruption and ileus were seen. Then, he was retreated with ciprofloxacin (CPFX), kanamycin sulfate (KM) and prednisolone (PSL). Subsequently, we added RFP and further added calcium para-aminosalicylate (PAS). All these treatment was effective, and he was discharged from the hospital.