Reactions 1680, p109 - 2 Dec 2017
Interstitial pneumonia: case report
A 73-year-old man developed interstitial pneumonia during
treatment with dabigatran etexilate [dabigatran; dosage, route
and time to reaction onset not stated].
The man, who had a history of paroxysmal atrial fibrillation
and chronic heart failure, had been receiving anticoagulant
therapy with dabigatran etexilate for 24 months. He presented
with dry cough and exertional dyspnoea. On respiratory
system examination, he showed fine crackles at lower back.
Chest X-ray revealed lower field bilateral infiltration. Chest CT
scan demonstrated ground glass opacity and non-segmental
subpleural consolidation, which was consistent with
nonspecific interstitial pneumonia (NSIP) with organising
pneumonia (OP) pattern. He showed increased levels of KL-6,
neutrophil and eosinophil without anaemia as well as
The man’s dabigatran etexilate therapy was discontinued,
and bronchoscopy was done to check progress in his
condition. Bronchoalveolar lavage fluid (BALF) was not bloody.
He showed reduction in eosinophil and neutrophil levels. He
also showed lymphocytes of 17.7% and CD4/CD8 ratio of 1.81
in BALF with no signs of infection. Trans-bronchial lung biopsy
specimen demonstrated OP. His therapy was then switched to
warfarin from dabigatran etexilate. Two months after the
initiation of warfarin therapy, X-ray and Chest CT scan findings
showed improvement of the previously existing opacities. Six
months later, KL-6 levels returned to normal. Based on these
findings, a diagnosis of dabigatran etexilate-induced interstitial
pneumonia was made.
Author comment: "Drug-induced lung injury is diagnosed
on the basis of clinical examination and radiographic and
histological findings". "Cases that develop subacutely, as in
the present case, tend to be [nonspecific interstitial
pneumonia] or [organising pneumonia]." "Therefore, the
patient’s interstitial pneumonia was diagnosed to be a drug-
induced lung injury caused by dabigatran."
Yanagihara T, et al. Interstitial pneumonia caused by dabigatran. Respiratory
Medicine Case Reports 23: 10-12, Jan 2018. Available from: URL: http://
doi.org/10.1016/j.rmcr.2017.10.009 - Japan
Reactions 2 Dec 2017 No. 16800114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved