Acute Pneumonitis Associated with MOPP Chemotherapy of Hodgkin's Disease

Abstract

A case of a 69-year-old man admitted with procarbazine pneumonitis and a review of the literature are presented. The patient completed a second course of MOPP chemotherapy for Hodgkin's disease three days before admission. He presented with a recent onset of fever, chills, anorexia, and malaise. Chest radiography indicated diffuse bilateral interstitial pneumonitis, and pulmonary function studies revealed restrictive lung disease. Attempts to identify an infectious etiology, including open lung biopsy, were negative, and empirical antibiotic therapy was ineffective. The diagnosis was drug-induced hypersensitivity reaction, most likely due to procarbazine. Corticosteroid therapy was instituted with gradual improvement. Six other cases of pneumonitis associated with procarbazine therapy are briefly reviewed, and the use of pulmonary function tests to identify the type and degree of injury and monitor therapy is discussed.

Hypersensitivity to Procarbazine and Severe RSV Pneumonia in a Child with Hodgkin’s Lymphoma

“…While these reactions are well known side effects for some certain chemotherapeutics, procarbazine related hypersensitivity reactions including fever, skin reactions, and pulmonary reactions have been reported uncommonly. [1][2][3][4][5][6][7][8][9][10][11][12][13] Procarbazine is effectively used in combination chemotherapy regimens for treatment of HL.…”

“…2 While pulmonary hypersensitivity is a well recognised toxicity of several anticancer drugs, particularly bleomycin, busulfan, methotrexate, and carmustine; procarbazine related pulmonary toxicity has been only rarely reported. 2,3,[8][9][10][11][12][13] Acute or delayed serious, even life-treating, pulmonary toxicity due to procarbazine can occur and may lead to reversible or permanent pulmonary damage. 2,3,[8][9][10][11][12][13] Delayed life threating pneumonitis due to rechallange with procarbazine in patients who initially had skin hypersensitivity reactions to procarbazine had been reported.…”

“…[9][10][11][12] We did not give him corticosteroid therapy for the management of pneumonitis because RSV was documented during a febrile neutropenic episode. In pediatric oncology patients RSV infections have been uncommonly reported.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] Hypersensitivity to procarbazine is particularly uncommon during childhood. [6][7][8] Here we report on a child with Hodgkin's lymphoma (HL) who developed procarbazine induced skin hypersensitivity reactions, and then severe pneumonia due to the respiratory syncytial virus (RSV) while receiving procarbazine, and bleomycin containing chemotherapy.…”