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Captopril-induced hypersensitivity lung disease. An immune-complex-mediated phenomenon
P L Schatz1, D Mesologites, J Hyun
1Saint Francis Hospital and Medical Center, Hartford, CT 06105.
Chest
|March 1, 1989
Summary
Captopril, a medication for high blood pressure, may cause rare lung hypersensitivity reactions. This case highlights potential immune-mediated lung disease in patients experiencing cough and eosinophilia after captopril use.
Area of Science:
- Pulmonology
- Nephrology
- Immunology
Background:
- Captopril is a widely used angiotensin-converting enzyme (ACE) inhibitor for hypertension, congestive heart failure, and chronic renal failure.
- Hypersensitivity lung disease is a known adverse effect of some medications, but captopril is not typically listed.
- Identifying drug-induced lung disease is crucial for patient management and preventing further harm.
Observation:
- A patient with a history of hypertension, congestive heart failure, and chronic renal failure developed respiratory symptoms upon rechallenge with captopril.
- The patient presented with productive cough and significant peripheral eosinophilia.
- Imaging and biopsy revealed upper lung field infiltrates consistent with an immune-mediated process.
Findings:
- Histologic findings from transbronchial biopsy and direct immunofluorescence supported an immune-complex-mediated hypersensitivity reaction.
- Gallium scan results were also consistent with this diagnosis.
- No alternative causes for the patient's eosinophilia or lung infiltrates, such as infection, were identified.
Implications:
- This case suggests captopril may be an underrecognized cause of hypersensitivity lung disease.
- Clinicians should consider captopril-induced lung disease in patients presenting with unexplained eosinophilia and pulmonary infiltrates.
- Early recognition and withdrawal of the offending drug are essential for managing immune-mediated hypersensitivity reactions.