[A non-cardiogenic type of pulmonary edema after administration of Chinese herbal medicine (shosaikoto)--a case report].

A 78-year-old woman was admitted to our institution because of dyspnea on exertion. The history of the present illness indicated that for past two years, she had been taking a Chinese herbal medicine (Shosaikoto), believed to be used for the treatment of liver dysfunction of unknown etiology. A chest radiograph showed a butterfly shadow in the middle of the lower lung fields. The arterial blood gases showed marked hypoxemia. A tentative diagnosis of drug-induced pneumonia was made, and so she was given methylprednisolone pulse therapy, but no improvement was seen. Acute respiratory failure occurred, and artificial mechanical ventilation was instituted with positive end-expiratory pressure (PEEP). Bronchoalveolar lavage revealed a bloody fluid which suggested alveolar extravasation of red blood cells. She was given a second course of pulse therapy, and the pulmonary edema began to resolve, and so corticosteroid was tapered off. She was then discharged. In the outpatient clinic, a lymphocyte stimulating test was performed, and showed a positive reaction for Shosaikoto. The above findings suggested Shosaikoto-induced non-cardiogenic pulmonary edema, a rarely seen disorder.