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Fatal interstitial lung disease associated with oral erlotinib therapy for lung cancer
Demosthenes Makris, Arnaud Scherpereel, Marie Copin, Guillaume Colin, Luc Brun, Jean Lafitte, Charles Marquette
BMC Cancer , 2007, DOI: 10.1186/1471-2407-7-150
Abstract: The medical record of a patient who developed fatal ILD after receiving erlotinib treatment was reviewed to identify the cause of death and other factors potentially contributive to this adverse outcome. A 55-year-old smoker with no evidence of pre-existing interstitial disease developed bilateral ILD and respiratory failure which could be explained only as a toxicity of erlotinib. He had a history of stage IV left upper lobe squamous-cell carcinoma for which he had received three successive regimens of chemotherapy (ifosfamide plus gemcitabine, docetaxel, mitomycin plus navelbine), followed five months later by erlotinib. At initiation of erlotinib treatment there were no radiological signs suggestive of ILD disease or apparent clinical signs of respiratory distress. While the patient completed two months with erlotinib therapy he developed bilateral interstitial infiltrates; despite discontinuation of erlotinib he was admitted with respiratory failure two weeks later. Diagnostic work up for other causes of pneumonitis including infectious diseases, congestive cardiac failure and pulmonary infraction was negative. Empiric treatment with oxygene, corticosteroids and later with cyclophosphamide was ineffective and the patient progressively deteriorated and died. The clinical and post-mortem examination findings are presented and the possible association relationship between erlotinib induced ILD and previous chemotherapy is discussed.Physicians should be alert to the fact that erlotinib related ILD, although infrequent, is potential fatal. The association between selective EGFR-inhibitors and ILD should be further investigated.Erlotinib (Tarceva?) is an Epidermal Growth Factor Receptor Type 1/tyrosine kinase (HER1/EGFR) inhibitor. The development of erlotinib in the treatment of advanced non-small-cell-lung cancer (NSCLC) raised a great enthusiasm among physicians. The initial safety and efficacy clinical studies showed some prolonged remissions and, in some cases, d
Interstitial pneumonitis following intrapleural chemotherapy
Luis Zappa, Renaldo Savady, Gary N Humphries, Paul H Sugarbaker
World Journal of Surgical Oncology , 2009, DOI: 10.1186/1477-7819-7-17
Abstract: In this case report a patient developed persistent right upper lobe interstitial pneumonitis and progressive parenchymal fibrosis following intrapleural chemotherapy treatment with mitomycin C and doxrubicin. The condition persisted until death 28 months later. Death was from progressive intraabdominal disease with intestinal obstruction and sepsis associated with progressive pulmonary parenchymal disease. The right pleural space disease did not recur.This manuscript is the first case report describing interstitial pneumonitis and lung fibrosis following intrapleural chemotherapy. Since pulmonary toxicity from chemotherapy is a dose-dependent phenomenon, dose reduction of intrapleural as compared to intraperitoneal hyperthermic chemotherapy may be necessary.Pseudomyxoma peritonei is the clinical syndrome of mucinous ascites associated with diffuse peritoneal implants of mucin-producing neoplasms [1,2]. It shows varying amounts of invasiveness and histologically the neoplasms producing pseudomyxoma peritonei can be classified as low grade and high grade mucinous carcinomas [3,4]. Appendiceal epithelial cancers represent 1% of colorectal cancers in the USA [5]. Almost all patients with appendiceal mucinous neoplasms have no lymphatic or haematogenous dissemination. Intrathoracic dissemination that occurs from penetration of the diaphragm by the intraabdominal mucinous tumor is rare but does occur in patients with pseudomyxoma peritonei [6]. In the absence of progressive disease in the abdomen, pleurectomy and intrapleural chemotherapy have been used to treat pleural dissemination with excellent clinical results and low morbidity [7]. In this report we present a patient with appendiceal mucinous neoplasm with right pleural dissemination treated by pleurectomy and intrapleural hyperthermic chemotherapy. Acute interstitial pneumonitis was followed by a debilitating long-term fibrosis.A 48-year-old woman in early 2004 developed increasing abdominal girth associated with d
Paclitaxel induced chronic fibrosing interstitial pneumonitis: a case report and review of the literature
Renata Ferrarotto,Guilherme Schetino,Daniela Freitas,Vera Capelozzi
Oncology Reviews , 2011, DOI: 10.4081/53
Abstract: Pulmonary toxicity is rarely associated with paclitaxel chemotherapy and its mechanism is not well known. This report describes one patient with pancreatic adenocarcinoma, metastatic neuroendocrine low-grade pancreatic tumor, and a concomitant stage I non-small cell lung cancer (NSCLC), who also developed life-threatening paclitaxel-induced chronic fibrosing interstitial pneumonitis. Giving the gravity of the condition and the not-wellestablished treatment, physicians should be aware of the possibility of chronic fibrosing interstitial lung disease during the course of paclitaxel containing regimens in patients who present with respiratory symptoms.
Chlorambucil-Induced Acute Interstitial Pneumonitis  [PDF]
Hammad Shafqat,Adam J. Olszewski
Case Reports in Hematology , 2014, DOI: 10.1155/2014/575417
Abstract: Chlorambucil is an alkylating agent commonly used in treatment of chronic lymphocytic leukemia (CLL). We report a case of interstitial pneumonitis developing in an 83-year-old man 1.5 months after completing a six-month course of chlorambucil for CLL. The interstitial pneumonitis responded to therapy with prednisone. We performed a systematic review of literature and identified 13 other case reports of chlorambucil-induced pulmonary toxicity, particularly interstitial pneumonitis. No unifying risk factor could be discerned and the mechanism of injury remains unknown. In contrast, major randomized trials of chlorambucil therapy in CLL have not reported interstitial pneumonitis as an adverse effect, which may be due to the rarity of the phenomenon or due to underreporting of events occurring after completion of treatment. Clinicians should consider drug-induced interstitial pneumonitis in the differential diagnosis of a suggestive syndrome developing even after discontinuation of chlorambucil. 1. Introduction Chlorambucil is an alkylating agent used for treatment of indolent lymphoproliferative disorders, particularly chronic lymphocytic leukemia (CLL) [1]. It is a relatively well-tolerated drug with myelosuppression constituting its principal toxicity [2]. Other alkylating agents such as busulfan and cyclophosphamide have been implicated in toxic lung injury [3]. Data regarding chlorambucil-induced lung injury is however very limited and consists of scattered case reports. Pulmonary toxicity has been reported as a dose-independent adverse effect of chlorambucil occurring during or after discontinuation of the therapy. We report a case of chlorambucil-induced interstitial pneumonitis along with a systematic review of literature summarizing the evidence of lung toxicity as a rare adverse effect of the agent. 2. Case Report An 83-year-old man presented to our hospital with acute onset of dyspnea and hypoxia. The patient had been diagnosed with CLL 14 months prior to the event, with asymptomatic lymphocytosis of 15.5?×?109/L, evidence of CD5, CD23, and CD38-positive, CD10-negative B-cell leukemia on flow cytometry, hemoglobin of 133?g/L, and platelet count of 132?×?109/L. After 8 months of watchful waiting he experienced progressive adenopathy and thrombocytopenia, which constituted indications for therapy. The patient received single-agent oral chlorambucil at the dose of 0.6?mg/kg every 14 days for 6 months. There were no significant toxicities during therapy, which resulted in a partial remission of CLL and resolution of adenopathy and cytopenias. Six
Carbamazepine-Induced Lymphocytic Interstitial Pneumonitis
Ebru Damado?lu,Cüneyt Saltürk,Ebru Sulu,Sevda G?kceer
Respiratory Case Reports , 2013, DOI: 10.5505/respircase.2012.02486
Abstract: A twenty-seven-year-old male was admitted with cough, sputum production, dyspnea and weight loss. Postero-anterior chest x-ray showed bilateral, diffuse reticulonoduler infiltration. He had received tuberculosis treatment in the past and he had been on carbamazepine for 8 years for a seizure disorder. Three sputum smear examinations for acid-fast bacilli were negative. Pulmonary function tests revealed FVC of 2.35L (51 %), FEV1 of 2.12 L (54 %), FEV1/FVC of 90 %, DLCO of 39 % and DLCO/VA of 75 %. Fiberoptic bronchoscopy was normal. Transbronchial lung biopsy and bronchial washing were nondiagnostic. Right mini-thoracotomy and open lung biopsy were performed. Pathologic examination revealed diagnosis of lymphocytic interstitial pneumonitis. Carbamazepine was withdrawn after neurological consultation. The patient was clinically and functionally well two months later. Computed tomography of the thorax was completely normal. The patient was consideredto be compatible with carbamazepine-induced lymphocytic interstitial pneumonitis.
Undiagnosed HIV Presenting with Lymphoid Interstitial Pneumonitis
Jason J. Rizqallah,Christopher T. Shah,Oladoyin Oluwole,John N. Sheagren
Case Reports in Infectious Diseases , 2011, DOI: 10.1155/2011/246706
Abstract: Undiagnosed or untreated human immunodeficiency virus infection can lead to devastating complications. We present a case of a 41-year-old woman who was found to have HIV-related lymphoid interstitial pneumonitis. LIP is uncommon, and its presentation can be quite similar to that of other chronic lung conditions. This case illustrates one of the possible protean manifestations of untreated HIV and is a sobering reminder of the need to screen all adults for HIV infection. Additionally, further invasive diagnostic testing may be required to guide therapy in patients with advanced acquired immune deficiency syndrome. This patient's LIP was likely related to long-standing unrecognized HIV disease.
Four Cases of Interstitial Lung Disease Induced by Erlotinib and A Review of the Literatures  [cached]
Xiaoling WU,Guanghui GAO,Shengxiang REN,Caicun ZHOU
Chinese Journal of Lung Cancer , 2012, DOI: 10.3779/j.issn.1009-3419.2012.08.08
Abstract: Erlotinib is an agent of oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors which are used for non-small cell lung cancer. Although this class of agents is considered to be relatively safe, the most serious, but rare, adverse reaction is drug-associated interstitial lung disease (ILD). ILD induced by gefitinib been often described, but the ILD induced by erlotinib is relatively less well known. We here describle four cases of ILD related to erlotinib and review recent literatures to help physicians earlier alert erlotinib-induced ILD. It is important to carefully monitor pulmonary symptoms in all patients who are receiving erlotinib. Early diagnosis and timely intervention is critical in the treatment of drug-induced ILD.
Fatal pneumonia by Legionella in a farmer with hypersensitivity pneumonitis
García López,Vega; Ordoqui García,Elena; Ferrer Gimeno,Teresa; Irisarri Orta,Jacinto; García Esteban,Marta; Barricarte Gurrea,Aurelio;
Medicina y Seguridad del Trabajo , 2009, DOI: 10.4321/S0465-546X2009000400003
Abstract: background: the retrospective investigation of a fatal sporadic legionnaires' disease identified an unknown case of occupational hypersensitivity pneumonitis in a swine breeder. methods: chest high-resolution computed tomography, bronchoalveolar lavage, lung biopsy, arterial gasometry, pulmonary function tests and autopsy were performed. it was studied the presence of legionella by serology and risk water samples were analyzed to identify the legionella's source. results: hp and legionella pneumophila pneumonia diagnostics were confirmed. lung fibrosis, a restrictive functional pattern, decreased diffusion, hypoxemia and bronchoalveolar lavage lymphocytosis were evidenced. legionella′s source was detected in a shower and a positive serology in the patient. autopsy verified pulmonary fibrosis and the septic shock leaded to legionella causing the death. conclusions: chronic cough and pulmonary infiltrates in a farmer should suspect the presence of hypersensitivity pneumonitis. later diagnosis carries a worse prognosis, the offending antigens exposure can't be avoided and fibrotic stage enhanced opportunity infection disease.
Diagnosis and management of interstitial pneumonitis associated with interferon therapy for chronic hepatitis C
Fan-Pu Ji, Zheng-Xiao Li, Hong Deng, Hong-An Xue, Yuan Liu, Min Li
World Journal of Gastroenterology , 2010,
Abstract: Interstitial pneumonitis (IP) is an uncommon pulmonary complication associated with interferon (IFN) therapy for chronic hepatitis C virus (HCV) infection. Pneumonitis can occur at any stage of HCV treatment, ranging from 2 to 48 wk, usually in the first 12 wk. Its most common symptoms are dyspnoea, dry cough, fever, fatigue, arthralgia or myalgia, and anorexia, which are reversible in most cases after cessation of IFN therapy with a mean subsequent recovery time of 7.5 wk. Bronchoalveolar lavage in combination with chest high resolution computed tomography has a high diagnostic value. Prompt discontinuation of medication is the cornerstone, and corticosteroid therapy may not be essential for patients with mild-moderate pulmonary functional impairment. The severity of pulmonary injury is associated with the rapid development of IP. We suggest that methylprednisolone pulse therapy followed by low dose prednisolone for a short term is necessary to minimize the risk of fatal pulmonary damage if signs of significant pulmonary toxicity occur in earlier stage. Clinicians should be aware of the potential pulmonary complication related to the drug, so that an early and opportune diagnosis can be made.
Interstitial pneumonitis secondary to intravesical bacillus calmette-guerin for carcinoma in-situ of the bladder
Diner, Eric K.;Verghese, Mohan;
International braz j urol , 2004, DOI: 10.1590/S1677-55382004000500008
Abstract: we report an 81-year-old male who developed severe interstitial pneumonitis on maintenance intravesical bacillus calmette-guerin (bcg) for in-situ carcinoma of the bladder. the patient was treated with steroids and anti-tuberculin therapy with complete response. while there is no established standard of care for the treatment of interstitial pneumonitis, recent reports describe success with combination of corticosteroids and anti-tuberculin medications. we elected to follow this precedent and treated our patient with corticosteroids and anti-tuberculin therapy with good outcome.
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