Abstract
A 73-year-old woman presented at the department of dermatology because of alopecia and erythema of the outer ear (auricle) in August 2006. The results of tests for antinuclear antibodies were positive, and systemic lupus erythematosus was suspected. The patient was followed up with no medication because there was no evidence of organ disease. In April 2007, edema of the lower extremities developed. The patient was admitted to the hospital because of nephrotic syndrome. A renal biopsy revealed type IV lupus nephritis. Prednisolone was given in a dose of 60 mg. Because urinary findings did not improve, cyclophosphamide was additionally given intravenously. Pneumonia developed after 2 weeks, when the second dose of cyclophosphamide was administered. Cytomegalovirus pneumonia was diagnosed, and ganciclovir was given. Despite treatment, acute respiratory failure occurred, and the patient received artificial ventilation. Radiographic findings improved, along with an improvement in arterial-blood gases. While respiratory status was improving, however, interstitial pneumonia developed. Drug-induced lung damage was suspected, and all drugs were discontinued. Signs and symptoms of pneumonia improved. The results of a drug lymphocyte stimulation test were positive for ganciclovir and ciprofloxacin.
We described our experience with a patient who had systemic lupus erythematosus associated with drug-induced lung damage, developing during treatment for cytomegalovirus pneumonia. Infection and underlying disease were difficult to distinguish from drug-induced lung damage on the basis of radiographic findings. A correct diagnosis required evaluations of physical findings and clinical course.
