漢方薬による薬剤性膀胱炎の小児例

Drug-induced cystitis：two cases report：caused by chinese herb

症例1は5歳，女児。主訴は二次性夜尿，排尿時痛，頻尿。尿路感染症が疑われて抗生剤を投与されたが症状は改善しないため，膀胱鏡検査施行。広範な炎症所見を認め，粘膜生検の病理組織検査は非特異的炎症であった。検査後，以前から柴朴湯を内服していたことが判明し，同薬を休薬したところ，1か月で症状は消退し，尿所見は正常化した。症例2は2歳，女児。主訴は頻尿，排尿時痛，尿混濁。セフェム系抗生剤による治療に抵抗性のため，膀胱鏡検査施行。広範な炎症所見を認めた。検査後，尿抗酸菌検査で塗抹陽性が遷延したが，ポリメラーゼ連鎖反応検査で結核菌および非定型抗酸菌感染は否定的であった。その後他医で漢方薬を3剤処方されていることがわかり，これらを休薬したところ症状，尿所見ともに改善した。

Case 1．A 5-year-old girl with recurrence of nocturnal enuresis and painful urination, had taken Saiboku-to for 9 months because of coughing. Administration of antibiotics for pyuria was ineffective. Cystoscopy revealed extensive inflammation and the pathlogical examination of the bladder mucosa showed atypical cystitis with predominantly lymphocytes infiltration. After bladder biopsy, we ceased the administration of Saiboku-to, then she became completely improved 1 month after cessation of Saiboku-to. Case 2．A 2-year-old girl complained grosshematuria and painful urination. Administration of several kinds of antibiotics for pyuria was ineffective. The symptoms persisted for 10 months, and we found that she had taken 3 agents of Chinese herbs. Cessation of these herbs completely improved the symptoms and resolved pyuria. We concluded that the Chinese herbs have caused drug-induced cystitis. Reviews of the literature were also performed.