Case 264

 We present a sixty-year-old female for mild fever of 37℃ level, cough and headache. She had been given prednisolone 60mg/day for a month for eosinophilic pneumonia associated with hemolytic pneumonia and thereafter, which decreased to 40mg/day, 30mg/day, 20mg/day, 15mg/day, 10mg/day and 7.5mg/day until then. She was admitted for suspicious recurrent eosinophilic pneumonia. Laboratory test at admission revealed albumin 2.8g/dL, CRP 10.97 mg/dL, white blood cells 9380/mm3, D dimer 5.1μg/mL (> 0.1), platelet 147000/mm3. IL2R 787 U/mL (> 496), IgG4 21.8mg/dL (>135).
 Seven days later, white blood cells count and CRP elevated to 11400/mm3 and 14.0 mg/dL and platelet count decreased to 81000/mm3.
 Two weeks later, albumin 2.3g/dL, CRP 17.29 mg/dL, white blood cells 16830/mm3, D dimer 16.9μg/mL (> 0.1), fibrinogen 497.2mg/dL (200-400), platelet 67000/mm3.
 She received CT for further investigation (Figs. 1-3).

What is the interleukin causing TAFRO syndrome ?

1.　Interleukin 2

2.　Interleukin 6

3.　Interleukin 12

4.　Vascular endothelial growth factor

5.　Vascular permeability factor

answer

222.4.21