Drug-induced lung injury caused by acetaminophen in a Japanese woman: A case report

Table 1 Laboratory and serological test findings representative of atypical or interstitial pneumonia at admission

Parameter	Recorded value	Standard range
White blood cell count	8310/µL	4500-7500/µL
Neutrophil	86.50%
Lymphocyte	11.70%
Monocyte	1.70%
Eosinophils	0.00%
Hemoglobin	11.8 g/dL	11.3-15.2 g/dL
Platelet count	23.2 × 103/µL	13-35 × 103/µL
Total protein	6.9 g/dL	6.9-8.4 g/dL
Albumin	3.5 g/dL	3.9-5.1 g/dL
Total bilirubin	0.7 mg/dL	0.2-1.2 mg/dL
Aspartate aminotransferase	31 U/L	11-30 U/L
Alanine aminotransferase	26 U/L	4-30 U/L
Lactase dehydrogenase	368 U/L	109-216 U/L
Blood urea nitrogen	9.6 mg/dL	8-20 mg/dL
Creatinine	0.5 mg/dL	0.63-1.03 mg/dL
Sodium	135 mEq/L	135-145 mEq/L
Potassium	4.2 mEq/L	3.6-5.2 mEq/L
Chlorine	98 mEq/L	98-108 mEq/L
C-reactive protein	31.65 mg/L	≤ 1.0 mg/L
Procalcitonin	0.66 ng/mL	≤ 0.3 ng/mL
KL-6	205 U/mL	≤ 500 U/mL
Surfactant protein A	105.9 ng/mL	≤ 43.8 ng/mL
Surfactant protein D	105.3 ng/mL	≤ 110 ng/mL
C3	136 mg/dL	86-160 mg/dL
C4	28.7 mg/dL	17-45 mg/dL
IgG	1137 mg/dL	870-1700 mg/dL
IgA	193 mg/dL	110-410 mg/dL
IgM	134 mg/dL	35-220 mg/dL
ACE	15.2 U/mL	8.3-21.4 U/mL
Antinuclear antibody	< 40	< 40
RF	< 3 U/mL	0-15 U/mL
Anti-CCP antibody	0.8 U/mL	< 5 U/mL
Anti-Ro/SS-A antibody	Negative	Negative
Anti-La/SS-B antibody	Negative	Negative
Anti-Jo-1 antibody	Negative	Negative
Anti-ARS antibody	Negative	Negative
PR3-ANCA	Negative	Negative
MPO-ANCA	Negative	Negative
Orientia tsutsugamushi Karp IgG	< 10	< 10
Orientia tsutsugamushi Karp IgM	< 10	< 10
Orientia tsutsugamushi Kato IgG	< 10	< 10
Orientia tsutsugamushi Kato IgM	< 10	< 10
Orientia tsutsugamushi Gilliam IgG	< 10	< 10
Orientia tsutsugamushi Gilliam IgM	< 10	< 10
C. pneumoniae IgG	Negative	Negative
C. pneumoniae IgA	Negative	Negative
CMV-IgG	199.7	0.0-1.0
CMV-IgM	< 0.85	0-0.7
M. pneumoniae PCR of the sputum	Negative	Negative
Urine Legionella antigen testing	Negative	Negative
Beta-D-glucan assay	9.0 pg/mL
Aspergillus IgG	Negative	Negative
Anti-Trichosporon asahii antibody	Negative	Negative

ACE: Angiotensin I-converting enzyme; ANCA: Antineutrophil cytoplasmic antibodies; ARS: Aminoacyl tRNA synthetase; C. pneumoniae: Chlamydia pneumoniae; CCP: Cyclic citrullinated peptide; CMV: Cytomegalovirus; Ig: Immunoglobulin; KL-6: Sialylated carbohydrate antigen KL-6; M. pneumoniae: Mycoplasma pneumoniae; MPO: Myeloperoxidase; PCR: Polymerase chain reaction; PR3: Proteinase 3; RF: Rheumatoid factor.

Table 2 Clinical characteristics of patients with reported acetaminophen-induced lung injury

Case	Sex	Age (years)	Ethnicity	Drugs	Symptoms	Time between drug use and presentation (d)	Time between initial diagnosis and drug discontinuation (d)	Treatment	Outcome	Ref.
1	Female	20	Japanese	Acetaminophen (Norshin®)	Fever, cough, and dyspnea	2	0	Drug discontinuation; Corticosteroids	Disease resolution	Kitaguchi et al[10], 1992
2	Female	63	Japanese	Acetaminophen (Caronal®)	Cough and dyspnea	8	10	Drug discontinuation; Corticosteroids	Disease resolution	Kudeken et al[11], 1993
3	Male	45	Japanese	Acetaminophen (PL Combination Granules®)	Fever, cough, and diarrhea	4	0	Drug discontinuation	Disease resolution	Nakatsumi et al[12], 1994
4	Male	75	Japanese	Acetaminophen (Pabron gold®/Pabron S®)	Fever and dyspnea	3	0	Drug discontinuation; Corticosteroids	Disease resolution	Nomura et al[13], 1997
5	Male	57	Japanese	Acetaminophen (PL Combination Granules® /Shin Lulu A Tablets®)	Fever, cough, and dyspnea	11	8 months	Drug discontinuation; Corticosteroids	Respiration and disease resolution	Kawano et al[14], 1997
6	Female	64	Japanese	Acetaminophen (Caronal®)	Fever, cough, and dyspnea	19	8	Drug discontinuation; Corticosteroids	Disease resolution	Akashi et al[15], 1997
7	Female	70	Japanese	Acetaminophen (Caronal®)	Fever, cough, and dyspnea	6	5	Drug discontinuation; Corticosteroids	Disease resolution	Nakajima et al[16], 1998
8	Female	49	Japanese	Acetaminophen (Benza Block SP®)	Fever and dyspnea	5	5	Drug discontinuation; Corticosteroids	Disease resolution	Nakajima et al[16], 1998
9	Male	72	Japanese	Acetaminophen (PL Combination Granules®)	Fever and dyspnea	1	0	Drug discontinuation; Corticosteroids	Respiration and Disease resolution	Ikeuchi et al[17], 2000
10	Male	31	Japanese	Acetaminophen (PL Combination Granules®)	Fever and cough	13	31	Drug discontinuation	disease resolution	Hiramatsu et al[18], 2002
11	Female	68	Japanese	Acetaminophen (PL Combination Granules®)	Fever, cough, and dyspnea	6	0	Drug discontinuation; Corticosteroids, Cyclosporine	Disease resolution	Nakayama et al[19], 2006
12	Female	41	Japanese	Acetaminophen (Ibuprofen®/Caronal®)	Fever, cough, and dyspnea	3	0	Drug discontinuation; Corticosteroids	Disease resolution	Anan et al[20], 2009
13	Female	84	Japanese	Acetaminophen (Shin Lulu A Tablets s®)	Fever, cough, and dyspnea	5	0	Drug discontinuation; Corticosteroids	Disease resolution	Kato et al[21], 2010
14	Female	80	Japanese	Acetaminophen (Caronal®)	Fever and dyspnea	15	0	Drug discontinuation; Corticosteroids	Disease resolution	Sasaki et al[22], 2014
15	Female	68	Caucasian	Acetaminophen (Caronal®)	Cough and dyspnea	Months	Not specified	Drug discontinuation	Disease resolution	Saint-Pierre et al[23], 2016
16	Female	79	Japanese	Acetaminophen (Caronal®)	Dyspnea	2	0	Drug discontinuation; Corticosteroids	Disease resolution	Ueda et al[24], 2019
Present case	Female	35	Japanese	Acetaminophen (Caronal®)	Fever	4	11	Drug discontinuation	Disease resolution	-