Diagnosis and Management of Drug-Induced Interstitial Lung Disease Associated with Amikacin Liposome Inhalation Suspension in Refractory Mycobacterium Avium Complex Pulmonary Disease: A Case Report

Abstract

Kazuki Hashimoto, Takuro Nii, Hitoshi Sumitani, Masashi Yokoyama, Satoshi Miyamoto, Yasuhiro Mihashi, Yuka Nagata, Takanori Matsuki, Kazuyuki Tsujino, Keisuke Miki, Hiroshi Kida Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, JapanCorrespondence: Takuro Nii, Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan, Tel [phone], Fax [phone], Email [email protected]: Amikacin liposome inhalation suspension (ALIS) is a key drug for the treatment of refractory Mycobacterium avium complex pulmonary disease (MAC-PD). Although cases of drug-induced interstitial lung disease (DIILD) by ALIS have been reported, its diagnosis is challenging due to overlapping existing pulmonary shadows, airway bleeding, exacerbation of underlying conditions, and the potential for various concurrent infections. A 72-year-old woman started treatment with ALIS for refractory MAC-PD. Three weeks later, she had a fever, cough, and appetite loss. She was hospitalized because multiple infiltrative opacities were observed on chest X-ray and chest computed tomography. Because the opacities worsened after empiric antibiotic therapy with broad-spectrum antibiotics, we initiated corticosteroid therapy, suspecting DIILD caused by ALIS, although drug lymphocyte stimulation tests for ALIS and amikacin were negative. Three days later, we found signs of improvement and quickly tapered the corticosteroids. After obtaining informed consent, we performed a drug provocation test of ALIS. Seven days later, she exhibited fever, an increased peripheral white blood cell count, and elevated serum C-reactive protein level, all of which returned to baseline 4 days after stopping ALIS, leading to a diagnosis of DIILD caused by ALIS in this patient. DIILD caused by ALIS is rare but should be carefully diagnosed to ensure that patients with refractory MAC-PD do not miss the opportunity to receive ALIS treatment.Keywords: amikacin liposome inhalation suspension, Mycobacterium avium complex pulmonary disease, drug-induced interstitial lung disease, drug provocation test, paradoxical response

Keywords

• amikacin liposome inhalation suspension mycobacterium avium complex pulmonary disease drug-induced interstitial lung disease drug provocation test paradoxical response