Clinical Review Lesson of the week

Clarithromycin and pulmonary infiltration with eosinophilia

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7403.1377 (Published 19 June 2003) Cite this as: BMJ 2003;326:1377
  1. Claudio Terzano, professor (cterzano@tin.it),
  2. Angelo Petroianni, respiratory physician
  1. Respiratory Diseases Unit, Department of Cardiovascular and Respiratory Sciences, University of Rome (La Sapienza), Rome, Italy
  1. Correspondence to: Claudio Terzano Via Ugo Bartolomei 18, Rome 00136, Italy
  • Accepted 24 December 2002

Introduction

Pulmonary diseases induced by drugs include bronchial asthma, pulmonary infiltration with eosinophilia, diffuse fibrosing alveolitis, vasculitis, and pleural diseases.14 Most such diseases recede when the drug is withdrawn, although on rare occasions the pulmonary damage is irreversible and progressive.4 5 We describe a patient with asthma referred to our respiratory diseases clinic who twice developed fever and pulmonary infiltration with eosinophilia after taking antibiotics.

Case report

A 17 year old white man who has had bronchial asthma since childhood was referred to our clinic in January 2002. The patient also reported sinusitis and allergic rhinitis. Results of earlier prick tests and radioallergosorbent tests were positive for wall pellitory (Parietaria judaica) and grasses, and the tests resulted in a mild increase in peripheral blood eosinophil counts (0.6-0.7 × 109/l (6-7%)). His general practitioner had prescribed salbutamol as a rescue treatment. The patient did not report any allergy to drugs.

In December 2001 he had reported fever (38°C), accompanied by mucopurulent nasal secretion and pain in his forehead. X ray pictures of the paranasal sinuses showed maxillary sinusitis on the right side and hypertrophy of the turbinates. The general practitioner prescribed combined amoxicillin (875 mg) and clavulanic acid (125 mg) twice daily for seven days, followed by clarithromycin (500 mg) twice daily for a further seven days. Figure 1 shows the patient's course of treatment. At the end of this treatment period the patient reported dry cough and mild dyspnoea. Chest x ray pictures showed pulmonary consolidations localised at the right apex.

Fig 1

Temporal relation between the patient's course of treatment and pulmonary infiltration …

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