Acute lung injury occasionally occurs after chemotherapy, but pulmonary toxicities by oxaliplatin-based chemotherapy have rarely been identified. A 76-year-old female with rectosigmoid colon cancer presented with ongoing dyspnea after the eighth cycle of standard chemotherapy (5-fluorouracil, sodium folinic acid, and oxaliplatin: FOLFOX). Nodular consolidation progressed despite antibiotics and BAL fluid analysis was compatible with the diagnosis of sarcoidosis. Corticosteroid therapy rapidly improved the symptoms and radiographic findings. We report this first case of secondary sarcoidosis related to FOLFOX therapy with review of references. 1. Introduction The standard palliative treatment for patients with advanced or metastatic colorectal cancer, consisting of oxaliplatin or irinotecan and 5-fluorouracil (5-FU) based chemotherapy, can extend patient’s survival up to 22 months [1–3]. The usual adverse effects following these regimens are hematological (13–52%), gastrointestinal (10–33%), and neurological (0–8%) toxicities [4]. However despite the widespread application of this regimen, pulmonary toxicities of oxaliplatin-based chemotherapy are rarely reported. We recently observed a rare case of secondary sarcoidosis related to oxaliplatin-based chemotherapy that presented as progressive dyspnea. 2. Case Report A 76-year-old female never-smoker visited our hospital because of progressive dyspnea beginning one month ago. She had been diagnosed with rectosigmoid colon adenocarcinoma and had undergone low anterior resection and a total abdominal hysterectomy with bilateral salpingo-oophorectomy 8 months previously. Her surgical stage was T4bN0 because of direct invasion into the left ovary, but the initial computed tomography (CT) showed small uncertain nodules in liver and lung. After a second cycle of adjuvant 5-fluorouracil with leucovorin, positron-emission tomography (PET-CT) scan showed progression of liver metastasis with FDG-uptake (SUV 8.4), but the lung nodules in the left upper lobe were stable and without FDG-uptake. The chemotherapy regimen was changed to 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) and infused every other week without significant adverse events. After the fourth cycle of FOLFOX regimen, asymptomatic pulmonary embolism was detected and anticoagulation with warfarin had started. At completion of the eighth cycle, she complained of progressive dyspnea without other respiratory symptoms. In PET-CT, the size of previous pulmonary nodules had been decreased, but several other ill-defined nodules that showed FDG-uptake
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