박지원

509

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Single NSAID induced anaphylaxis

아주대학교병원 내과¹, 아주대학교 의과대학 면역/알레르기내과학교실²

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박지원

, 예영민

Diclofenac is one of the most commonly used non-steroidal anti-inflammatory drugs (NSAID). The adverse drug reactions of NSAID varies from common side effects such as gastritis, peptic ulceration to rare allergic reactions such as urticaria and anaphylaxis. Two pathogenic mechanisms are thought to be in- volved in the immediate hypersensitivity to NSAIDs: typical non-immunologic, cross-reactive hypersensitivity depending on the potency of the cyclo- oxygenase-1 inhibition and rare IgE-mediated allergic reactions. We experienced a

case of diclofenac-specific IgE-mediated hypersensitivity and hereby report with de- tailed investigation. A 36-year-old female was brought to our hospital who developed generalized urticaria, hypotension, and dyspnea after diclofenac injection. Oral prov- ocation tests with celecoxib, aspirin and ibuprofen were negative. Intradermal tests with diclofenac and ketolac were performed, and the patient showed positive only to diclofenac, suggesting the selective hypersensitivity to diclofenac with concomitant tolerance to other NSAIDs. Basophil activation test (BAT) and an ELISA with diclo- fenac-HSA conjugate resulted in increase in CD203c expression on her basophil sur- face upon stimulating with diclofenac in dose-dependent manner as well as, diclofe- nac-specific IgE was detected in her sera using by ELISA. Finally the patient was di- agnosed with diclofenac-induced anaphylaxis by IgE-mediated mechanism. It has been recommended for the patients with adverse drug reactions to any NSAIDs to avoid all NSAID administration due to its cross-reaction, however, given that the di- agnosis of drug-specific hypersensitivity is possible through BAT and ELISA, it is now advisable to screen patients with single NSAID-induced hypersensitivity.

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Diagnostic utility of chest CT scan in chronic cough patients with normal chest X-rays

서울아산병원 내과

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임진아, 안진, 이지향, 한아름, 이세원, 권혁수, 이재승, 김태범, 오연목, 조유숙, 이상도, 문희범, 송우정

Background/Aims: Chest computed tomography (CT) scan may be considered to exclude rare causes in patients with chronic cough, but the diagnostic utility is still unclear. This study aimed to examine a utility of chest CT scan in detecting critical lung diseases in chronic cough patients with normal chest X-ray (CXR), unremarkable medical history and physical examination. Methods: A retrospective medical record review was conducted for patients re- ferred to a tertiary hospital with chronic cough between 2010 and 2018. Inclusion criteria were 1) aged ≥ 18 years old, 2) presenting with chronic cough (≥

8 weeks in duration), 3) having normal CXR, 4) having normal chest physical examination, 5) having no history of serious systemic diseases such as malig- nancy or autoimmune disease, and 6) undergoing chest CT scan for cough within 6 months after the CXR. Primary outcome in CT scans was the diagnosis of ‘critical’ lung diseases, including malignancy, infectious pneumonia and active tuberculosis, which warrant prompt diagnosis and treatment. Findings of non-malignant or non-infectious conditions were classified as being ‘non-critical’. Negative predictive value (NPV) of normal CXR in excluding the crit- ical lung diseases was calculated. Results: Among 7,315 chronic cough patients, 418 subjects met the inclusion criteria. CT scans were normal in 153 pa- tients (36.6％). ‘Critical’ lung diseases were found in 6 patients (1.4％); lung cancer (n=2; 1 confirmed and 1 suspected), pneumonia (n=2), suspected lym- phoma (n=1) and active tuberculosis (n=1). ‘Non-critical’ conditions were found in 259 patients (61.9％); fibrocalcified lesions were the most frequent le- sions (Table 1). The NPV of normal CXR in excluding the critical lung conditions was 98.6％. Meanwhile, there were no significant differences between patients with normal CT findings and with the critical diseases in baseline parameters including age, sex, smoking history and cough duration.

Conclusions: NPV of normal CXR in excluding critical lung diseases was 98.6％ among a tertiary hospital sample of chronic cough patients who under- went chest CT scans. Given potential harmful effects from CT radiation, risk-benefit balance should be considered in the clinical decision making.