Tuberc Respir Dis.  2010 Oct;69(4):293-297. 10.4046/trd.2010.69.4.293.

Bronchiolitis Obliterans Organizing Pneumonia in the Patient with Non-Small Cell Lung Cancer Treated with Docetaxel/Cisplatin Chemotherapy: A Case Report

• Kim AR
• Kim TY
• Lee YM
• Lee SH
• Jung SJ
• Lee HK

• KMID: 2114625
• DOI: http://doi.org/10.4046/trd.2010.69.4.293

Abstract

A 60-year-old man was diagnosed with stage IV squamous cell carcinoma of lung and treated with weekly doses of docetaxel and cisplatin. Tumor mass and mediastinal lymphadenopathy disappeared after 4.5 cycles of chemotherapy. At one week post final chemotherapy, the patients developed sudden shortness of breath. New, multifocal infiltrations developed on both lungs without definitive evidence of infection. Despite administration of broad spectrum antibiotics, the lung lesion did not improve, so bronchoalveolar lavage and computed tomography-guided lung biopsy were performed. The proportion of lymphocytes was increased markedly and histopathology revealed squamous cell carcinoma combined with bronchiolitis obliterans organizing pneumonia. After high dose corticosteroid therapy, dyspnea and the newly developed consolidation had decreased slightly. However, dyspnea and hypoxemia increased again because of aggravated lung cancer since chemotherapy had stopped. Chemotherapy couldn't be restarted due to the poor performance status of the patient. Later, patient died of respiratory failure from poor general condition and progression of lung cancer.

Keyword

Cryptogenic Organizing Pneumonia; Docetaxel; Lung Neoplasms; Drug Therapy

MeSH Terms

Anoxia
Anti-Bacterial Agents
Biopsy
Bronchiolitis
Bronchiolitis Obliterans
Bronchoalveolar Lavage
Carcinoma, Non-Small-Cell Lung
Carcinoma, Squamous Cell
Cisplatin
Cryptogenic Organizing Pneumonia
Dyspnea
Humans
Lung
Lung Neoplasms
Lymphatic Diseases
Lymphocytes
Middle Aged
Respiratory Insufficiency
Taxoids
Anti-Bacterial Agents
Cisplatin
Taxoids

Figure

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  Figure 1 Initial chest X-ray shows multifocal consolidation on right and left lower lung.

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  Figure 2 Chest CT shows luminal narrowing of right lower lobe bronchus, interlobular septal thickening, peribronchial consolidation on right lower lobe and bilateral pleural effusion.

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  Figure 3 Chest CT shows improved luminal narrowing of right lower lobe bronchus, nearly disappeared right lower lobe consolidation and pleural effusion.

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  Figure 4 Radiographic findings after development of dyspnea. Chest X-ray (A) and chest CT (B) show multifocal patchy consolidations on the right lung.

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  Figure 5 The microscopic finding of needle biopsied lung tissue reveals plugging of loose fibrotic material in small airway and alveolar spaces (right side) and a few squamous cell carcinoma nests are also noted with artificial craft formation (left box) (H&E stain, ×40) (Inlet: higher magnification of left box, H&E stain, ×200).

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  Figure 6 Radiographic findings of 45 days from methylprednisolone treatment. Multifocal consolidations on right lung decreased but tumor mass and lymphangitic metastases aggravated compared to precious chest CT.

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