Microsoft word - a case of interstitial pneumonia suspected to be due to spirulinatm.doc

A Case of Interstitial Pneumonia suspected to be due to SpirulinaTM  Kitazawa Y, Saito F, Tomino A and Fujii H  Department of Emergency and Critical Care Medicine, Kansai Medical University Hirakata Hospital, Hirakata-city, Osaka, JAPAN  Objective: A 59 years old male with a complaint of dyspnea consulted us. The laboratory test on
admission included leukocytosis, positive CRP, negative Tropmonon-T, and low PO2 of 38.4 mmHg. The
chest X-P provided a widely-spread shadow in the broad fields. The supersonic study indicated slight
cardiac congestion. The culture examination provided no specific pathogen. Case Report: We started
the administration of diuretics, to fail to improve his hypoxia. Suspecting of an interstitial pneumonia,
the administration of corticosteroid was started and all the previously administrated medicine were
discontinued. After the steroid- therapy was started, pulmonary oxygenation ability disorder was
improved remarkably. On the seventh hospital day, the X-P shadow was normalized, and the oxygen
supply was discontinued. The steroid- therapy was discontinued 3 weeks after. The patient was
discharged on 25 hospital day. Since then, the pneumonia has not been reoccurred. The
concentration of KL-6 was within the normal range. The drug lymphocyte stimulating tests (DLST)
were performed targeting glimepiride, voglibose, rebamipide, estazolam, to obtain no positive data.
Later, we figured out that the patient had been taking SpirulinaTM until the admission. We
performed another DLST targeting SpirulinaTM and obtained the result of strongly positive (SI:
318%). Discussion: The dramatic effect of corticosteroid and the data of the DLST indicate it as drug-
induced interstitial pneumonia caused by SpirulinaTM taken for years. SpirulinaTM inhabited a lot in
the subtropical zone of Africa and Central/South America mainly, and has been taken from the
ancient times. Many beneficial effects of SpirulinaTM for human health have been reported, while
their mechanisms have not been elucidated yet. SpirulinaTM has been reported to have the side
effects of nausea, dyspepsia, constipation, hypotension, dizziness, hyperglycemia. However, all of
these side effects should not be seriously concerned. Among various pulmonary diseases, interstitial
pneumonia is rare but often lethal. There are some reports that 1 to 5 % of interstitial pneumonias of
admitted patients are induced by medicines (1)(2). An early diagnosis followed by early treatment is
important to prevent drug-induced death. Conclusion: Our case suggests that SpirulinaTM should be
recognized as one of the dangerous foods because of its probable cumulative toxicity to cause
interstitial pneumonia. DLST should be performed as a supporting diagnosis when an allergic factor
is assumed. References: 1. Friedman GD, et al. Experience in monitoring drug reactions. JAMA,
1971; 217: 567-572., 2. Koch-Wester J. Fatal reactions to drug therapy. N Engl J Med, 1974; 291:
302-303. 

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