Tuberc Respir Dis.  2013 May;74(5):235-239. 10.4046/trd.2013.74.5.235.

Fatal Interstitial Pneumonitis Rapidly Developed after the First Cycle of CHOP with Etoposide Combination Chemotherapy in a Patient with Lymphoma

• Park HC
• Ahn JS
• Yang DH
• Jung SH
• Oh IJ
• Choi S
• Lee SS
• Kim MY
• Kim YK
• Kim HJ
• Lee JJ

• KMID: 2050893
• DOI: http://doi.org/10.4046/trd.2013.74.5.235

Abstract

Several chemotherapeutic agents are known to develop pulmonary toxicities in cancer patients, although the frequency of incidence varies. Cyclophosphamide is a commonly encountered agent that is toxic to the lung. Additionally, granulocyte colony-stimulating factor (G-CSF) being used for the recovery from neutropenia can exacerbate lung injury. However, most of the patients reported previously that the drug-induced interstitial pneumonitis were developed after three to four cycles of chemotherapy. Hereby, we report a case of peripheral T cell lymphoma which rapidly developed a fatal interstitial pneumonitis after the first cycle of combined chemotherapy with cyclophosphamide, adriamycin, vincristine, prednisolone, and etoposide and the patient had also treated with G-CSF during neutropenic period.

Keyword

Lymphoma; Lung Diseases, Interstitial; Granulocyte Colony-Stimulating Factor; Drug Therapy

MeSH Terms

Cyclophosphamide
Doxorubicin
Drug Therapy, Combination
Etoposide
Granulocyte Colony-Stimulating Factor
Humans
Incidence
Lung
Lung Diseases, Interstitial
Lung Injury
Lymphoma
Lymphoma, T-Cell, Peripheral
Neutropenia
Prednisolone
Vincristine
Cyclophosphamide
Doxorubicin
Etoposide
Granulocyte Colony-Stimulating Factor
Prednisolone
Vincristine

Figure

• 

  Figure 1 Positron emission tomography scan showing disseminated lymphomatous involvements in the tonsils, spleen, left anterior chest wall, and multiple lymph nodes on both sides of the diaphragm.

• 

  Figure 2 Follow-up chest computed tomography scan during chemotherapy. (A) At diagnosis of peripheral T cell lymphoma, not otherwise specified, multiple lymph node enlargement and diffuse centrilobular emphysema were observed. (B) After the first cycle of chemotherapy with cyclophosphamide, adriamycin, vincristine, and prednisolone along with etoposide, the scan shows newly-developed diffused ground glass opacities with reticulation and peripheral predominance in both lungs.

• 

  Figure 3 (A) Chest X-ray scans at diagnosis of drug-induced interstitial pneumonitis shows diffused ground glass appearance with reticulation in both lung. (B) After 32th-day of prednisone treatment, chest X-ray scans show remarkable aggravation of diffused interstitial lung infiltration throughout the entire lung.

• 

  Figure 4 Chest computed tomography (CT) scan showing small amounts of newly appearing pneumomediastinum (black arrow), without evidence of aero-digestive tract injury (B) comparison with the follow-up chest CT on 30th days after the first cycle of chemotherapy with cyclophosphamide, adriamycin, vincristine, and prednisolone along with etoposide (A).

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