Tuberc Respir Dis TRD Tuberculosis and Respiratory Diseases 1738-3536 The Korean Academy of Tuberculosis and Respiratory Diseases 10.4046/trd.2008.65.5.416 Case Report A Case of Recurrent Pneumonitis Caused by Bojungikgitang(Bu-Zhong-Yi-Qi-Tang) Kim Seung Gu M.D. 1 Kang Gun Hi M.D. 1 Kim Jun Jae M.D. 1 Park Hyun M.D. 1 Baek Na Na M.D. 1 Choi Sang Bong M.D. 1 Shin Eun Ah M.D. 2 Kim Joung Sook M.D. 3 Park I Nae M.D. 1 Jeung Hoon M.D. 1 Hur Jin Won M.D. 1 Lee Sung Soon M.D. 1 Lee Hyun Kyung M.D. 1 Kim Joo In M.D. 1 Lee Young Min M.D. 1 Lee Hyuk Pyo M.D. 1 Yum Ho Kee M.D. 1 Choi Soo Jeon M.D. 1 Department of Internal Medicine, Paik Hospital, Inje University College of Medicine, Seoul, Korea. Department of Pathology, Paik Hospital, Inje University College of Medicine, Seoul, Korea. Department of Radiology, Paik Hospital, Inje University College of Medicine, Seoul, Korea. Address for correspondence: Soo Jeon Choi, M.D. Department of Internal Medicine, Inje University Sanggye Paik Hospital, 761-1, Sanggye 7-dong, Nowon-gu, Seoul 139-707, Korea. Phone: 82-2-950-1990, Fax: 82-2-950-1954, choisj@paik.ac.kr 11 2008 30 11 2008 65 5 416 420 22 08 2008 24 09 2008 Copyright © 2008 The Korean Academy of Tuberculosis and Respiratory Diseases 2008

Many classes of drug, such as antineoplastic drugs and antiarrhythmic drugs, have potential to induce interstitial lung disease. Herbal medicines are also believed to have the potential to induce pneumonitis. However, to our knowledge, there are no reports of pneumonitis caused by herbal medications in the Korean medical database. We report a case of recurrent pneumonitis caused by a self rechallenge of the Herbal medicine Bojungikgitang (Bu-Zhong-Yi-Qi-Tang : Hochu-ekki-to).

 Pneumonitis Herbal medicine Bu-Zhong-Yi-Qi-Tang (Hochu-ekki-to) Murray JF Nadel JA Mason RJ Broaddus VC Textbook of respiratory medicine 2005 4th ed Philadelphia, PA Saunders Tsukiyama K Tasaka Y Nakajima M Hino J Nakahama C Okimoto N A case of pneumonitis due to sho-saiko-to Nihon Kyobu Shikkan Gakkai Zasshi 1989 27 1556 1561 Maruyama Y Maruyama M Takada T Haraguchi M Uno K A case of pneumonitis due to Rikkunshi-to Nihon Kyobu Shikkan Gakkai Zasshi 1994 32 84 89 Temaru R Yamashita N Matsui S Ohta T Kawasaki A Kobayashi M A case of drug induced pneumonitis caused by saiboku-To Nihon Kyobu Shikkan Gakkai Zasshi 1994 32 485 490 Takeshita K Saisho Y Kitamura K Kaburagi N Funabiki T Inamura T Pneumonitis induced by ou-gon (scullcap) Intern Med 2001 40 764 768 Katayama H Hamada H Yokoyama A Kadowaki T Ito R Higaki J A case of interstitial pneumonia caused by gosha-jinki-gan Nippon Ronen Igakkai Zasshi 2004 41 675 678 Hata Y Uehara H A case where herbal medicine sho-seiryu-to induced interstitial pneumonitis Nihon Kokyuki Gakkai Zasshi 2005 43 23 31 Toyoshima M Chida K Suda T Harada M A case of pneumonitis caused by Seisin-renshi-in, herbal medicine Nihon Kokyuki Gakkai Zasshi 2008 46 31 34 Kawasaki A Mizushima Y Kunitani H Kitagawa M Kobayashi M A useful diagnostic method for drug-induced pneumonitis: a case report Am J Chin Med 1994 22 329 336 Yum HK Han SH Kim HG Lee HK Jeon WK Lee YW A case of gold induced hypersensitivity pneumonitis diagnosed by lymphocyte stimulation test with gold Tuberc Respir Dis 1994 41 546 551 Matsuno O Okubo T Hiroshige S Takenaka R Ono E Ueno T Drug-induced lymphocyte stimulation test is not useful for the diagnosis of drug-induced pneumonia Tohoku J Exp Med 2007 212 49 53 Shiota Y Wilson JG Matsumoto H Munemasa M Okamura M Hiyama J Adult respiratory distress syndrome induced by a Chinese medicine, Kamisyoyosan Intern Med 1996 35 494 496 Ikegami F Sumino M Fujii Y Akiba T Satoh T Pharmacology and toxicology of Bupleurum root-containing Kampo medicines in clinical use Hum Exp Toxicol 2006 25 481 494 Inoue T Tanaka E Sakuramoto M Minakuchi M Maeda Y Tanizawa K A case of drug-induced pleuritis, possibly due to Hochuekkito Nihon Kokyuki Gakkai Zasshi 2007 45 258 261 Akira M Ishikawa H Yamamoto S Drug-induced pneumonitis: thin-section CT findings in 60 patients Radiology 2002 224 852 860

Chest PA shows diffuse bilateral haziness in both lower lobes with decreased lung volume.

Chest HRCT scan on admission. HRCT shows bilateral peribronchial and subpleural ground glass opacities with mild bronchial dilatation in both lungs.

Pathologic findings of transbronchial lung biopsy shows mild interstitial fibrosis with lymphocytic infiltration (H&E stain, ×200) (A) and focal intra-alveolar histiocytic aggregation (H&E stain, ×200) (B).

Chest PA findings after methylprednisolone pulse therapy. Findings of previous bilateral haziness, linear atelectasis and cardiomegaly were marked improved compared to admission day, and those findings were went on.

Chest PA shows relapsed bilateral haziness in both lower lobes, after retreatment of Bojungikitang.

Chest PA findings after methylprednisolone treatment. Bilateral haziness was cleared.