Chronic eosinophilic pneumonia after trastuzumab and radiation therapy for breast cancer

Abstract

Rationale:Chronic eosinophilic pneumonia (CEP) is rare and an idiopathic disorder. The disease has been associated with drugs, infection, or irradiation, and its relationship with asthma remains unclear.Patient concerns:We reported a case of a 49-year-old female patient after trastuzumab and radiation therapy for breast cancer. Two months after radiation treatment, the patient complained of productive cough, progressive breathlessness, occasional wheezing, and left pectoralgia.Diagnoses:Computed tomography (CT) scan revealed infiltrates in lungs. Without evidence of infection, marked increased eosinophils in a transbronchial biopsy performed from the left upper lobe confirmed the diagnosis of CEP after trastuzumab and radiation therapy.Interventions:The patient was started with oral prednisone at 0.5 mg/kg/day.Outcomes:A CT scan of the chest obtained 2 weeks after steroid treatment showed diminishment of the lesions, and at the 6-month follow-up, the patient had no complaints of discomfort with no relapse of pulmonary lesions.Lessons:Physicians should consider CEP as a diagnosis in patients who have had previous exposure to trastuzumab and radiation therapy, especially with a history of asthma. Timely diagnosis and treatment may benefit these patients.

Dupilumab and the potential risk of eosinophilic pneumonia: case report, literature review, and FAERS database analysis

“…The most common drug factors include antibiotics such as daptomycin, minocycline, and nitrofurantoin, which frequently result in chronic EP ( 6 ). With the advent of new therapeutic drugs, there has been an increase in reports of EP induced by immunotherapeutic drugs, including immune checkpoint inhibitors, immunomodulators, and biological targeted drugs ( 20 – 23 ). However, overall, EP caused by the dupilumab monoclonal antibody is not common, with isolated reports of dupilumab being used to treat CEP ( 19 , 24 ).…”

<p>Eosinophilic Pneumonia Associated With Natalizumab In A Patient With Multiple Sclerosis: A Case Report And Literature Review</p>

“…The summary of cases with respiratory adverse events associated with natalizumab is shown in Table 2. However, the biologic agents are reported to have something to do with EP 17,18Table 2Summary Of Cases With Respiratory Adverse Events Associated With NatalizumabReferenceRespiratory Adverse EventAgeSexUnderlying DiseasePeripheral Blood EosinophilEosinophilIn BALF11NTM28FRRMSN/AN/A12NTMN/AN/ARRMSN/AN/A13Tb45FRRMSN/AN/A13Tb47FRRMSN/AN/A14PCM46MRRMSN/AN/A15Sarcoidosis38MCDN/AN/A15Sarcoidosis37MCDN/AN/A16Suspected EP41FRRMS490/µL12%Our caseEP39FRRMS5520/µL35%…”