J Korean Med Sci.  2012 Apr;27(4):450-453. 10.3346/jkms.2012.27.4.450.

Temozolomide-Associated Bronchiolitis Obliterans Organizing Pneumonia Successfully Treated with High-Dose Corticosteroid

• Kim TO
• Oh IJ
• Kang HW
• Chi SY
• Ban HJ
• Kwon YS
• Kim KS
• Kim YI
• Lim SC
• Kim YC

• KMID: 2157909
• DOI: http://doi.org/10.3346/jkms.2012.27.4.450

Abstract

Temozolomide is an oral alkylating agent with clinical activity against glioblastoma multiforme (GM). It is generally well-tolerated and has few pulmonary side effects. We report a case of temozolomide-associated brochiolitis obliterans organizing pneumonia (BOOP) requiring very high-dose corticosteroid treatment. A 56-yr-old woman presented with a 2-week history of exertional dyspnea. For the treatment of GM diagnosed 4 months previously, she had undergone surgery followed by chemoradiotherapy, and then planned adjuvant chemotherapy with temozolomide. After the 1st cycle, progressive dyspnea was gradually developed. Chest radiograph showed diffuse patchy peribronchovascular ground-glass opacities in both lungs. Conventional dose of methylprednisolone (1 mg/kg/day) was begun for the possibility of BOOP. Although transbronchial lung biopsy findings were compatible with BOOP, the patient's clinical course was more aggravated until hospital day 5. After the dose of methylprednisolone was increased (500 mg/day for 5 days) radiologic findings were improved dramatically.

Keyword

Bronchiolitis Obliterans Organizing Pneumonia (BOOP); Temozolomide; Methylprednisolone

MeSH Terms

Antineoplastic Agents, Alkylating/*adverse effects/therapeutic use
Cryptogenic Organizing Pneumonia/*chemically induced/*drug therapy/radiography
Dacarbazine/adverse effects/*analogs & derivatives/therapeutic use
Dyspnea/etiology
Female
Glioblastoma/drug therapy/radiography
Glucocorticoids/*therapeutic use
Humans
Methylprednisolone/therapeutic use
Middle Aged
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Serial radiographic changes of the patient. Chest radiography at admission (A) shows multiple bilateral patchy nodular and interstitial opacities in both lungs. The consolidations are more aggravated at 5th hospital day (B). After high-dose corticosteroid treatment, the lesions are improved at 21st hospital day (C) and outpatient clinic examination (D).

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  Fig. 2 Chest computed tomography (CT) at admission (A, B) shows diffuse patchy and nodular peribronchovascular ground-glass opacities and fine reticulations with mild parenchymal distorsion in both lungs. CT acquired on the 5th hospital day (C, D) reveals increased extent and density of ground-glass opacities with aggravated parenchymal distorsion and traction bronchiectatic changes in both lungs. Moderate amount of pleural effusion is also observed.

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  Fig. 3 Pathology of transbronchial lung biopsy. Myxoid fibroblastic plugs are shown within intra-alveolar spaces (H&E, × 40).

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