Camostat mesilate is in widespread clinical use mainly to treat chronic pancreatitis and drug-induced lung injury has not been previously reported. lymphocyte stimulation test; GGO ground glass opacities; HRCT High-resolution computed tomography 1 Any drugs can cause lung injury and their clinical conditions are miscellaneous. Camostat mesilate is in widespread clinical use mainly to treat chronic pancreatitis and the number of people who takes this drug during one year is estimated at about a hundred thousand. Generally this drug is believed to be safe and secure; indeed camostat mesilate-induced lung injury has not been reported so far. Here we report the first case of camostat mesilate-induced acute eosinophilic pneumonia. 1.1 Evofosfamide Case presentation A 65-year-old man was given camostat mesilate (600?mg/day) for ten days due to pancreatitis after endoscopic retrograde cholangiopancreatography for the evaluations of cholangitis and pancreatic cyst. One week later he was admitted to our hospital suffering from low grade fever though abdominal symptom due to pancreatitis had been improved. Chest radiograph revealed bilateral fine nodular opacities in the middle and lower fields (Fig.?1). Fig.?1 Chest radiograph obtained on admission showing fine nodular opacities Evofosfamide in both middle and lower lung fields. Arterial blood gas analysis (ambient air) indicated that pH 7.466 PaCO2 32.8?mmHg and PaO2 63.7?mmHg. Results of additional laboratory examination were as follows: white blood cell count 7700/μL (eosinophils 52%) C-reactive protein 18.5?mg/dL (normal range <0.3?mg/dL) lactate dehydrogenase 250?IU/L (normal range <225?IU/L) IgE-RIST 166?IU/mL (normal range <170?IU/mL) surfactant proteins-D 54.6?ng/mL (normal range <110?ng/mL) Krebs von den Lungen-6 137?U/mL (normal range <500?U/mL) anti-nuclear antibody?Mouse monoclonal to WD repeat-containing protein 18 (GGO) and septal line thickenings with subpleural distribution in the middle and lower lobes (Fig.?2). The bronchoalveolar lavage fluid (BALF) results were as follows: Evofosfamide total cell counts 3.3?×?105/mL macrophages 22% eosinophils 77% and lymphocytes 1%. We found infective etiologies including viral tuberculous and fungal infections negative. Parasitic analysis for faecal specimen was also negative and there was no history of eating raw meat and fish. Transbronchial lung biopsy specimens revealed the accumulations of eosinophils in the alveolar space and interstitum with the mild edema of alveolar septa (Fig.?3). In addition the drug lymphocyte stimulation test (DLST) of peripheral blood for camostat mesilate was positive (stimulation index 493%). His temperature decreased and blood eosinophilia and pulmonary involvements were improved two weeks later with the cessation of the drug. Thus we concluded the case was acute eosinophilic pneumonia induced by camostat mesilate. Fig.?2 High-resolution computed tomography showed bilateral ground glass opacities and septal line thickenings with subpleural distribution in the middle and lower lobes. Fig.?3 Transbronchial lung biopsy specimens revealed the accumulations of eosinophils and macrophages in the alveolar space and interstitum with the mild edema of alveolar septa (Hematoxylin and Eosin staining?×?100). 2 Recently drug-induced lung injuries have been increasing as various drugs developed and such clinical conditions are diverse. However camostat mesilate and its analogous drugs serine protease inhibitors have rarely caused lung injury. The mechanism of pathogenesis is broadly divided into two categories i.e. toxic reaction and allergic reaction [1] [2]. The present case was thought to be allergic reaction. Allen proposed the five criteria for drug-induced eosinophilic lung disease [3]. Clinically the patient should: (A) have no other likely cause of lung disease (B) have symptoms consistent with the suspect drug (C) have a time course compatible with drug-induced lung disease (D) Evofosfamide have tissue Evofosfamide or BALF findings compatible with.

Camostat mesilate is in widespread clinical use mainly to treat chronic

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