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Secondary bronchiolitis obliterans organising pneumonia in a patient with carbamazepine-induced hypogammaglobulinemia

Division of Infectious and Respiratory Diseases, Department of Internal Medicine, Tohoku University Hospital, Sendai, Japan

Correspondence to:
Correspondence to:
Tsutomu Tamada
Division of Infectious and Respiratory Diseases, Department of Internal Medicine, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; tamada@rid.med.tohoku.ac.jp

The first 150 words of the full text of this article appear below.

A 49-year-old woman had been treated with carbamazepine for 2 years because of epilepsy. She was referred to us for progressive exertional dyspnea and prolonged productive cough. Chest computed tomography (CT) scan showed bilateral infiltrates including ground glass opacities and consolidations predominantly in the lower lung fields. Her laboratory findings showed severe hypogammaglobulinemia, that is, immunoglobulin (Ig) G 418 mg/dl (normal, 748–1694 mg/dl), Ig A 20 mg/dl (91–391 mg/dl) and Ig M 51 mg/dl (33–254 mg/dl). Carbamazepine and other suspected antibiotics were all negative for drug-induced lymphocyte stimulation tests. Histological examination by trans-bronchial lung biopsy showed intraluminal fibrosis of distal airspaces with foamy alveolar macrophages, suggesting bronchiolitis obliterans organising pneumonia (BOOP). After the cessation of carbamazepine, all abnormalities in gammaglobulins and roentgenogram findings gradually improved without any medication. This good clinical course also considerably supports the diagnosis of BOOP.

BOOP may result from diverse causes such as drugs, acute respiratory . . . [Full text of this article]