Acute Interstitial Pneumonitis During Chemo

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Eur J Cancer Care (Engl). 2005 Sep;14(4):336-41.

Acute interstitial pneumonitis during chemotherapy for haematological

malignancy.

Nakase K, Tsuji K, Nagaya S, Tamaki S, Tanigawa M, Ikeda T, Miyanishi

E, Shiku H.

The Second Department of Internal Medicine, Mie University School of

Medicine, Tsu, The Department of Internal Medicine, Yamada Red Cross

Hospital, Misono, Mie, Japan.

NAKASE K., TSUJI K., NAGAYA S., TAMAKI S., TANIGAWA M., IKEDA T.,

MIYANISHI E. & SHIKU H. (2005) European Journal of Cancer Care

Acute interstitial pneumonitis during chemotherapy for haematological

malignancy Fourteen adult patients with haematological malignancies

(eight non-Hodgkin's lymphoma, one multiple myeloma, one chronic

lymphocytic leukaemia, two acute lymphoblastic leukaemia and two

acute myeloid leukaemia) developed acute interstitial pneumonitis

(IP) during the course of chemotherapy. All patients manifested high

fever over 38 degrees C, bilateral diffuse pulmonary interstitial

infiltrates in the chest radiograph and severe hypoxia without

hypercapnia in the arterial blood gas analysis.

Pathogenic microorganisms were not detected in repeated examinations

in any patient. Chemotherapy given included various anti-neoplastic

drugs. Five patients had received granulocyte colony-stimulating

factor (G-CSF) for chemotherapy-induced leucopenia. The onset was

associated with an increase of leucocytes in 10 patients.

All patients were treated with high dose steroid hormone and broad

spectrum antibiotics with or without anti-fungal agents, and three

required mechanical ventilation.

Eleven patients quickly recovered from these situations, whereas

three died. Autopsies were done in two patients and disclosed

pneumocystis carinii (PC) pneumonitis in one and non-specific

pulmonary congestive oedema and fibrosis in the other.

In conclusion, IP of unknown cause could develop in patients with

various haematological malignancies especially at the recovery phase

of chemotherapy-induced leucopenia irrespective of the previous G-CSF

administration.

High dose steroid hormone should be used as therapy for such patients

as soon as possible after exclusion of an infective aetiology.

PMID: 16098118 [PubMed - in process]