Drug-induced pneumonitis detected earlier by 18F-FDG-PET than by high-resolution CT: a case report with non-Hodgkin’s lymphoma

Yamane, Toshimi; Daimaru, Osami; Ito, Satoshi; Nagata, T.; K, Yoshiya; Fukaya, Nobuyuki; S, Itó; Imai, Takeshi; Uchida, Hideo

doi:10.1007/s12149-008-0183-7

Cited by 21 publications

(8 citation statements)

References 11 publications

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“…Increased FDG-avidity in the lungs on FDG-PET scans has been reported in several patients with drug-induced ILD such as bleomycin, rituximab, etoposide, and paclitaxel, mostly as diffuse bilateral FDG-accumulation [29][30][31][32][33][34][35]. FDG-PET has been reported to detect ILD earlier than high resolution computed tomography [36]. Therefore, this may be an early marker of ILD.…”

Section: Clinical Evaluationmentioning

confidence: 98%

Prospective Study of Drug-induced Interstitial Lung Disease in Advanced Breast Cancer Patients Receiving Everolimus Plus Exemestane

Willemsen¹,

Tol

Erp

et al. 2019

Targ Oncol

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Background Everolimus-related interstitial lung disease (ILD) (also: pneumonitis) poses a difficulty for physicians, as it is hard to discriminate ILD from other causes of respiratory symptoms and to decide on safe treatment continuation. Objective We investigated the capability of pulmonary function tests (PFT), plasma biomarkers, everolimus pharmacokinetics, and FDG-PET to discriminate between everolimus-related ILD and other causes of respiratory problems and to predict the severity of ILD. Patients and methods Women starting treatment with everolimus plus exemestane for advanced breast cancer were included. At baseline and during the first 3 months, respiratory symptoms, PFT with diffusion capacity of the lungs for carbon monoxide corrected for hemoglobin (DLCOc) and forced vital capacity, serum plasma biomarkers (including SP-D and YKL-40), everolimus trough concentration, and 18 F-FDG-PET were prospectively recorded. Results Twenty-seven (out of 29 included) patients were evaluable for analysis. Fifteen patients (56%) developed everolimusrelated respiratory signs or symptoms and four patients (15%) needed everolimus discontinuation and received corticosteroids. Change in DLCOc differentiated ILD from alternative diagnoses with 0.91 sensitivity and 0.78 specificity. Decrease in DLCOc (non-significant) was greatest in patients who needed everolimus discontinuation. Serum SP-D and YKL-40 could differentiate ILD from alternative diagnoses with 0.83 and 0.83 sensitivity, and 0.85 and 0.62 specificity, respectively. 18 F-FDG-PET abnormalities did not precede clinical symptoms. No relationship between ILD and everolimus trough concentration was found. Conclusions This study shows that everolimus-related ILD occurs frequently. Prospective monitoring of DLCOc in combination with measurement of serum SP-D and YKL-40 appear useful to discriminate ILD from other causes of respiratory symptoms. Clinicaltrials.gov identifier: NCT01978171.

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Section: Clinical Evaluationmentioning

confidence: 98%

Prospective Study of Drug-induced Interstitial Lung Disease in Advanced Breast Cancer Patients Receiving Everolimus Plus Exemestane

Willemsen¹,

Tol

Erp

et al. 2019

Targ Oncol

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“…FDG uptake was detected at an extremely early stage when no symptoms or abnormal findings on HRCT were apparent [13,14]. PET positivity, however, has no specificity for DILD.…”

Section: Clinical Manifestations and Diagnosis Of Dildmentioning

confidence: 99%

Drug-induced interstitial lung disease: mechanisms and best diagnostic approaches

Matsuno¹

2012

Respir Res

230

188

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Drug-induced interstitial lung disease (DILD) is not uncommon and has many clinical patterns, ranging from benign infiltrates to life-threatening acute respiratory distress syndrome. There are two mechanisms involved in DILD, which are probably interdependent: one is direct, dose-dependent toxicity and the other is immune-mediated. Cytotoxic lung injury may result from direct injury to pneumocytes or the alveolar capillary endothelium. Drugs can induce all types of immunological reactions described by Gell and Coombs; however, most reactions in immune-mediated DILD may be T cell-mediated.DILD can be difficult to diagnose; diagnosis is often possible by exclusion alone. Identifying the causative drug that induces an allergy or cytotoxicity is essential for preventing secondary reactions.One method to confirm the diagnosis of a drug-induced disease is re-exposure or re-test of the drug. However, clinicians are reluctant to place patients at further risk of illness, particularly in cases with severe drug-induced diseases. Assessment of cell-mediated immunity has recently increased, because verifying the presence or absence of drug-sensitized lymphocytes can aid in confirmation of drug-induced disease. Using peripheral blood samples from drug-allergic patients, the drug-induced lymphocyte stimulation test (DLST) and the leukocyte migration test (LMT) can detect the presence of drug-sensitized T cells. However, these tests do not have a definite role in the diagnosis of DILD. This study explores the potential of these new tests and other similar tests in the diagnosis of DILD and provides a review of the relevant literature on this topic.

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“…Diffusely increased pulmonary FDG uptake has also been reported in cases of inflammatory and infectious pneumonitis, pulmonary contusion, and acute respiratory distress syndrome in which CT findings were initially absent or disproportionately less than FDG-PET findings. In each of these cases, CT findings progressed over 3-5 days with development of ground glass opacities or consolidation corresponding to the areas of increased uptake ( Table 2 ) [19] , [20] , [21] .…”

Section: Discussionmentioning

confidence: 98%

Intravascular large B-cell lymphoma presenting with diffusely increased pulmonary fluorodeoxyglucose uptake without corresponding CT abnormality

Spencer

Dusing

Yap

et al. 2019

Radiology Case Reports

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A 60-year-old male presented with complaints of dyspnea, intermittent fever, and 40 pounds of weight loss over the previous 9 months and was admitted for acute hypoxemic respiratory failure. Labs demonstrated elevated inflammatory markers, mild anemia, and thrombocytopenia. Fluorodeoxyglucose-positron emission tomography scan demonstrated diffusely increased pulmonary fluorodeoxyglucose uptake without corresponding abnormality on CT images. Excisional lung biopsy demonstrated intravascular large B-cell lymphoma (IV-LBCL). Presentation, imaging findings, and diagnosis of IV-LBCL will be discussed, as well as differential considerations for pulmonary involvement by IV-LBCL.

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Drug-induced pneumonitis detected earlier by 18F-FDG-PET than by high-resolution CT: a case report with non-Hodgkin’s lymphoma

Cited by 21 publications

References 11 publications

Prospective Study of Drug-induced Interstitial Lung Disease in Advanced Breast Cancer Patients Receiving Everolimus Plus Exemestane

Prospective Study of Drug-induced Interstitial Lung Disease in Advanced Breast Cancer Patients Receiving Everolimus Plus Exemestane

Drug-induced interstitial lung disease: mechanisms and best diagnostic approaches

Intravascular large B-cell lymphoma presenting with diffusely increased pulmonary fluorodeoxyglucose uptake without corresponding CT abnormality

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