Drugs induce a variety of
pulmonary diseases including pulmonary infiltration with
eosinophilia (PIE) syndrome. We report a case of PIE syndrome which was observed after
neck dissection. An 83-year-old male patient attended our clinic complaining of upper neck swelling and was diagnosed as advanced
lymph node metastasis related to previously resected oral
carcinoma and underwent
neck dissection. Despite administration of
antibiotics (
piperacillin sodium, PIPC; and
tosufloxacin tosilate, TFLX),
fever and an elevation of the
c-reactive protein (CRP) level with neutrophilia appeared, and an infiltration shadow was observed in the right lower pulmonary field. With the suspicion of
pneumonia, the
antibiotics were exchanged for
panipenem/betamipron. However, the pulmonary infiltration spread widely, CRP increased to 12.9 mg/dl and severe
eosinophilia (23%) was observed a few days after changing the
antibiotics. PIE syndrome was suspected, and the patient underwent
steroid mini-pulse
therapy consisting of
methylprednisolone sodium succinate (500 mg) and
prednisolone (60 mg). After
steroid therapy, the pulmonary condition largely improved. However, about 2 weeks after the start of
steroid administration, a
fever and a further elevation of CRP were observed with an increase of beta-
D-glucan in serum. Roentgenography revealed diffuse infiltration shadows throughout the lungs, and the patient died about 3 weeks after the onset from respiratory distress. In vitro, blastogenesis of patient's peripheral blood lymphocytes was strongly enhanced by PIPC and TFLX, and they generated a large amount of
interleukin-5 in the presence of PIPC or TFLX. The
clinical course and laboratory examination results revealed that PIE syndrome may have been induced by PIPC and TFLX and that PIE syndrome should be suspected in treatment of
carcinomas when
dyspnea and pulmonary infiltration are complicated with
eosinophilia.