2012 Volume 61 Issue 3 Pages 265-270
We report a case of drug-induced interstitial pneumonitis probably due to hangeshashinto prescribed for cheilitis. An 84-year-old woman came to our dental clinic complaining of erosion of the lower lip. She had a history of treatment for lumbar canal stenosis and had been prescribed limaprost alfadex for 3 years. Although she had been treated with steroidal ointment, vitamin B and cepharanthin by her dermatologist for 2 years, her symptom had not improved. Clinical examination revealed both erythematic and keratotic legions, and combined partially with desquamative erosion and crusting formation in the lower lip. A clinical diagnosis of cheilitis related to xerostomia was made, and we gave 15 mg of pilocarpine hydrochloride daily as well as steroidal ointment and several agents for oral rinse for 10 months with modest clinical efficacy. She then received 7.5 mg of Hangeshashinto daily for 3 weeks, which resulted in a complete response in the lip. However, she started to suffer dyspnea after 26 days from taking the medicine, and was referred to the regional general hospital. Since fine crackles were audible on auscultation and chest X-ray films showed widespread ground-glass shadows in both fields, drug-induced interstitial pneumonia was suspected. After cessation of the medicine and steroid pulse and successive oral steroidal therapies, her subjective symptoms improved considerably and the interstitial shadows observed on the chest X-ray films and chest CT were resolved.
