Reactions 1419 - 15 Sep 2012

SRiluzole

Acute lung injury in elderly patients: 2 casereports

Two elderly patients developed acute lung injury duringtreatment with riluzole [routes not stated] for amyotrophiclateral sclerosis (ALS).

A 69-year-old woman presented with a 2-week history ofdyspnoea on exertion and general fatigue. Three weeksearlier, she had started treatment with riluzole 50mgtwice daily. Her chest X-ray, in comparison with one taken5 months prior, revealed increased ground glass opacity(GGO) in both lower lungs. Her CT showed bilateral lowerlobe dorsal-dominant GGO and consolidation. Herperipheral blood drug lymphocyte stimulation test (DLST)was positive. Drug-induced lung injury was suspected, andriluzole was withdrawn. Five days later, her radiologicalfindings and symptoms remained unchanged. She washospitalised, and her histological examination showedintraalveolar fibrosis. She was treated with prednisolone.Subsequently, her radiological findings and generalcondition improved. Prednisolone was tapered down, andshe was stable at last follow-up.

An 83-year-old woman presented with a 2-week historyof dry cough on exertion. Five weeks earlier, she hadstarted treatment with riluzole 50mg twice daily. Her chestCT showed faint GGO in her right lower lobe. A diagnosiscould not be reached, and riluzole was continued withoutpatient follow-up. After 2 weeks, she still had dry cough.Her chest CT showed increased GGO and consolidation inbilateral dorsal lower lobes. Drug-induced lung injury wassuspected. Riluzole was withdrawn, and she washospitalised. Histological examination showedintraalveolar fibrosis, interstitial lymphocytic infiltrationand swollen type II pneumocytes. She was started onprednisolone. Subsequently, her radiological findings andgeneral condition improved. Her prednisolone was tapereddown, and she was stable at last follow-up. Of note, herbronchoalveolar lavage DLST was positive.

Author comment: "[W]e presented two cases of riluzole-induced pneumonitis in ALS. Both cases were acute, hadpositive DLSTs and histological findings on biopsy consistentwith lung injury."Kakuta T, et al. Riluzole-induced lung injury in two patients with amyotrophiclateral sclerosis. Internal Medicine 51: 1903-1907, No. 14, 15 Jul 2012. Availablefrom: URL: http://dx.doi.org/10.2169/internalmedicine.51.6522 -Japan 803076962

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Reactions 15 Sep 2012 No. 14190114-9954/10/1419-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved