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Different Responses to Clarithromycin in Patients with Cryptogenic Organizing Pneumonia.

Oh JH, Oh DJ, Koo SM, Kim YK, Kim KU, Kim HJ, Kim DW, Uh ST - Tuberc Respir Dis (Seoul) (2015)

Bottom Line: Macrolides have been used with success in those patients showing resistance to steroids.In this report, we described two cases of COP who showed different responses to clarithromycin.One recovered completely, but the other gradually showed lung fibrosis with clarithromycin.

View Article: PubMed Central - PubMed

Affiliation: Division of Allergy and Respiratory Medicine, Soonchunhyang University Hospital, Seoul, Korea.

ABSTRACT
Cryptogenic organizing pneumonia (COP) is an idiopathic interstitial pneumonia characterized by a subacute course and favorable prognosis with corticosteroids. However, some patients show resistance to steroids. Macrolides have been used with success in those patients showing resistance to steroids. A few reports showed treatment failure with macrolides in patients with COP who were resistant to steroids. In this report, we described two cases of COP who showed different responses to clarithromycin. One recovered completely, but the other gradually showed lung fibrosis with clarithromycin.

No MeSH data available.


Related in: MedlinePlus

Summary of treatment agents, clinical course, and radiologic findings. High resolution chest computerized tomogram of a case that worsened after 2 months treatment of prednisolone and 1-month treatment of cyclophosphamide (A), and improved with 3 months treatment with clarithromycin (B). High resolution computerized tomogram, lung function tests, and dyspnea improved 6 months after ceasing administration of clarithromycin (C). PDL: prednisolone; Cyclo: cyclophosphamide; Clarith: clarithromycin; FVC: forced vital capacity; DLco: diffusion capacity of lung; mMRC: modified British Medical Research Council.
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Figure 4: Summary of treatment agents, clinical course, and radiologic findings. High resolution chest computerized tomogram of a case that worsened after 2 months treatment of prednisolone and 1-month treatment of cyclophosphamide (A), and improved with 3 months treatment with clarithromycin (B). High resolution computerized tomogram, lung function tests, and dyspnea improved 6 months after ceasing administration of clarithromycin (C). PDL: prednisolone; Cyclo: cyclophosphamide; Clarith: clarithromycin; FVC: forced vital capacity; DLco: diffusion capacity of lung; mMRC: modified British Medical Research Council.

Mentions: Therapy was started with prednisolone (PDL, total 50 mg, 1 mg/kg/day) on 13th hospital day. Her symptoms, FVC, and HRCT were worsened after 1-month treatment of PDL. We added cyclophosphamide (total 100 mg, 2 mg/kg/day) for next 1 month together with PDL, but HRCT (Figure 4A), her symptoms, FVC worsened. Clarithromycin 500 mg was added with reduced dose of PDL. Cyclophosphamide was stopped with start with clarithromycin. At three months after treatment with clarithromycin, HRCT (Figure 4B), her symptoms (mMRC I), and FVC (63% of predicted value) much improved. After 6 months of stopping PDL and clarithromycin, she complained no respiratory symptoms, HRCT and FVC (81% of predicted value) became to really normal (Figure 4C).


Different Responses to Clarithromycin in Patients with Cryptogenic Organizing Pneumonia.

Oh JH, Oh DJ, Koo SM, Kim YK, Kim KU, Kim HJ, Kim DW, Uh ST - Tuberc Respir Dis (Seoul) (2015)

Summary of treatment agents, clinical course, and radiologic findings. High resolution chest computerized tomogram of a case that worsened after 2 months treatment of prednisolone and 1-month treatment of cyclophosphamide (A), and improved with 3 months treatment with clarithromycin (B). High resolution computerized tomogram, lung function tests, and dyspnea improved 6 months after ceasing administration of clarithromycin (C). PDL: prednisolone; Cyclo: cyclophosphamide; Clarith: clarithromycin; FVC: forced vital capacity; DLco: diffusion capacity of lung; mMRC: modified British Medical Research Council.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4620339&req=5

Figure 4: Summary of treatment agents, clinical course, and radiologic findings. High resolution chest computerized tomogram of a case that worsened after 2 months treatment of prednisolone and 1-month treatment of cyclophosphamide (A), and improved with 3 months treatment with clarithromycin (B). High resolution computerized tomogram, lung function tests, and dyspnea improved 6 months after ceasing administration of clarithromycin (C). PDL: prednisolone; Cyclo: cyclophosphamide; Clarith: clarithromycin; FVC: forced vital capacity; DLco: diffusion capacity of lung; mMRC: modified British Medical Research Council.
Mentions: Therapy was started with prednisolone (PDL, total 50 mg, 1 mg/kg/day) on 13th hospital day. Her symptoms, FVC, and HRCT were worsened after 1-month treatment of PDL. We added cyclophosphamide (total 100 mg, 2 mg/kg/day) for next 1 month together with PDL, but HRCT (Figure 4A), her symptoms, FVC worsened. Clarithromycin 500 mg was added with reduced dose of PDL. Cyclophosphamide was stopped with start with clarithromycin. At three months after treatment with clarithromycin, HRCT (Figure 4B), her symptoms (mMRC I), and FVC (63% of predicted value) much improved. After 6 months of stopping PDL and clarithromycin, she complained no respiratory symptoms, HRCT and FVC (81% of predicted value) became to really normal (Figure 4C).

Bottom Line: Macrolides have been used with success in those patients showing resistance to steroids.In this report, we described two cases of COP who showed different responses to clarithromycin.One recovered completely, but the other gradually showed lung fibrosis with clarithromycin.

View Article: PubMed Central - PubMed

Affiliation: Division of Allergy and Respiratory Medicine, Soonchunhyang University Hospital, Seoul, Korea.

ABSTRACT
Cryptogenic organizing pneumonia (COP) is an idiopathic interstitial pneumonia characterized by a subacute course and favorable prognosis with corticosteroids. However, some patients show resistance to steroids. Macrolides have been used with success in those patients showing resistance to steroids. A few reports showed treatment failure with macrolides in patients with COP who were resistant to steroids. In this report, we described two cases of COP who showed different responses to clarithromycin. One recovered completely, but the other gradually showed lung fibrosis with clarithromycin.

No MeSH data available.


Related in: MedlinePlus