Tuberc Respir Dis.  2010 Apr;68(4):226-230.

Bicalutamide-induced Interstitial Lung Disease

• Kim YK
• Kim YH
• Lee JJ
• Choi CW
• Yoo JH
• Park MJ
• Kang HM

Abstract

Androgen deprivation therapy, which is the standard treatment for metastatic prostate cancer, includes nonsteroidal antiandrogenic drugs, such as flutamide, nilutamide and bicalutamide. Of them, bicalutamide rarely induces interstitial pneumonia. We report a case of bicalutamide-induced interstitial pneumonia. A 68-year old male diagnosed with prostate cancer and multiple bone metastases presented with dry cough and low grade fever for 3 days. He had taken bicalutamide (50 mg/day) for 13 months. High resolution computed tomography revealed ground glass opacity in his right upper lung. The laboratory studies showed no eosinophilia in the serum and bronchoalveolar lavage fluid. Despite the use of antimicrobial agents for 2 weeks, the extent of the lung lesions increased to the left upper and right lower lung. He had no environmental exposure, collagen vascular disease and microbiological causes. Under the suspicion of bicalutamide-induced interstitial pneumonia, bicalutamide was stopped and prednisolone (1 mg/kg/day) was initiated. The symptoms and radiologic abnormalities were resolved with residual minimal fibrosis.

Keyword

Bicalutamide; Lung Diseases, Interstitial; Prostatic Neoplasms

MeSH Terms

Anilides
Anti-Infective Agents
Bronchoalveolar Lavage Fluid
Collagen
Cough
Environmental Exposure
Eosinophilia
Fever
Fibrosis
Flutamide
Glass
Humans
Imidazolidines
Lung
Lung Diseases, Interstitial
Male
Neoplasm Metastasis
Nitriles
Prednisolone
Prostatic Neoplasms
Tosyl Compounds
Vascular Diseases
Anilides
Anti-Infective Agents
Collagen
Flutamide
Imidazolidines
Nitriles
Prednisolone
Tosyl Compounds

Figure

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  Figure 1 (A) Chest radiography shows interstitial pneumonia in right upper lobe at the presentation. (B) Chest CT shows consolidation and bronchiectasis with cystic formation in right upper lobe at the presentation.

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  Figure 2 (A) Interstitial pneumonia extends to left upper lobe, compared with chest radiography at the presentation. (B) Chest CT shows newly developed diffuse interlobular septal thickening and ground glass attenuation with bronchiectasis in left upper lobe.

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  Figure 3 Microscopic finding of transbronchial lung biopsy shows interstitial fibrosis with mild interstitial chronic inflammatory cell infiltration and a few intra-alveolar macrophages (H&E stain, ×100).

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  Figure 4 (A) After one month of treatment, follow-up chest radiography shows significant improvement in both lung lesions. (B) After 3-months, follow-up chest CT shows the nearly complete resolution of ground glass opacities with mild residual fibrosis in both upper lobes of lung.

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