Drug-related pneumonitis with radiographic hypersensitivity pneumonitis pattern: Three case series

Nakamura, Yoriko; Takimoto, Takayuki; Kobayashi, Takehiko; Tachibana, Kazunobu; Kasai, Takahiko; Akira, M.; Arai, Toru; Inoue, Yoshikazu

doi:10.1016/j.rmcr.2021.101498

Cited by 3 publications

(4 citation statements)

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“…In other studies, the median KL-6 was 518.5 U/mL in 10 patients [ 35 ] and 571 U/mL in seven patients with DRP-HP [ 8 ] ( Table 1 ). Furthermore, we recently reported three cases of DRP-HP induced by nab-paclitaxel, everolimus, and nivolumab, and their serum KL-6 levels were normal [ 10 ]. These data are not comparable, because the definitions or statuses of common-HP and DRP-HP differ depending on the study.…”

Section: Serum Biomarkers Of Drp-hpmentioning

confidence: 99%

“…DRP-HP shows small, poorly defined centrilobular nodules with or without widespread areas of ground glass opacity or lobular areas of decreased attenuation and vascularity [ 7 ], which is comparable to the radiological pattern of non-fibrotic HP as previously described in the HP guideline. The reported incidence of DRP-HP varies between 2.3% and 33.3% among all cases of DRP, depending on the drug used, study, and inclusion criteria [ 6 , 8 , 9 , 10 ]. Recently, immunotherapy has become a standard of care in oncology [ 7 , 11 ], and DRP-HP induced by immune checkpoint inhibitors (ICIs) has been reported up to 16–22% of all ICI-related pneumonitis [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Recently, immunotherapy has become a standard of care in oncology [ 7 , 11 ], and DRP-HP induced by immune checkpoint inhibitors (ICIs) has been reported up to 16–22% of all ICI-related pneumonitis [ 11 , 12 ]. Thus, in terms of the clinical management of the disease, it is important to distinguish DRP-HP from other diseases, including common non-fibrotic (inhalation) or infectious diseases [ 10 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Serum Biomarkers in a Radiological Pattern of Non-Fibrotic Hypersensitivity Pneumonitis: Implications for Mechanistic Difference and Differential Diagnosis

Takimoto

Nakamura

2022

Diseases

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Hypersensitivity pneumonitis (HP) is a consequence of immune-mediated reactions caused by recurrent exposure to environmental agents. Recently, clinical practice guidelines for the diagnosis of HP were published and increased interest in HP. On the other hand, novel therapies have recently emerged for various diseases, and the management of drug-related pneumonitis (DRP) has become increasingly important. Among DRP, the HP pattern (DRP-HP) shows small, poorly defined centrilobular nodules with or without widespread areas of ground-glass opacity or lobular areas of decreased attenuation and vascularity. A similar radiological pattern of non-fibrotic HP can be induced, irrespective of inhalation (non-fibrotic HP) or intravenous administration (DRP-HP). However, their difference has not been well described, although the distribution of lesions in the lungs was slightly different between these two conditions. In this review, we focus on serum biomarkers of lung epithelial cells in order to investigate the difference between DRP-HP and non-fibrotic HP (common-HP). Serum levels of Krebs von den Lungen 6 (KL-6) might be relatively lower (occasionally normal) in DRP-HP than in common-HP, implying a mechanistic difference. KL-6 could be useful in discriminating between DRP and non-fibrotic HP (common type).

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Section: Serum Biomarkers Of Drp-hpmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Serum Biomarkers in a Radiological Pattern of Non-Fibrotic Hypersensitivity Pneumonitis: Implications for Mechanistic Difference and Differential Diagnosis

Takimoto

Nakamura

2022

Diseases

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“…These conditions range from benign infiltrates to severe, life-threatening lung diseases [ 3 , 4 ]. Despite numerous reports and growing recognition, the literature still lacks comprehensive data on the incidence and full spectrum of clinical presentations of DILD, compounded by challenges in diagnosis and underreporting [ 5 ]. The complexity of diagnosing DILD stems from its nonspecific symptoms and often requires advanced imaging techniques like high-resolution computed tomography (HRCT), which goes beyond routine chest radiography [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Incidence and Clinical Characteristics of Drug-Induced Lung Disease Among Chemotherapy Recipients

Cörüt,

Altundağ,

Eyüboğlu

2024

Cureus

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Background Chemotherapeutic agents treat cancer and some inflammatory diseases due to their immunosuppressive effects. While effective, these drugs can cause drug-induced lung disease (DILD), a serious adverse effect with limited data regarding its incidence and clinical presentation. Methods This retrospective study included 20 patients diagnosed with DILD out of 1,231 patients treated with chemotherapeutic agents who presented with symptoms such as cough, fever, dyspnea, and chest pain at an oncology outpatient clinic. Patients underwent assessments including clinical examination, chest radiography, high-resolution computed tomography, and, in some cases, video-assisted thoracoscopic surgery. A statistical analysis was performed to determine the incidence and evaluate the clinical characteristics of DILD. Results The incidence of DILD among patients treated with chemotherapeutic agents was 0.27%. The female/male ratio was 11/9, with a mean age of 53.2 years. Common symptoms included cough (70%), dyspnea (60%), fever (50%), and sputum production (40%). Imaging revealed pleural effusion, reticular patterns, and consolidation in varying proportions. Common agents causing pulmonary toxicity included bleomycin, cyclophosphamide, and methotrexate, among others. Importantly, 95% of patients showed improvement with steroid treatment, although statistical significance was not achieved (p > 0.05). Conclusion The findings highlight the need for heightened awareness and monitoring of DILD in patients receiving chemotherapeutic treatments. Early diagnosis and prompt treatment initiation are crucial to managing this potentially severe complication. This study underscores the importance of considering pulmonary risks when prescribing chemotherapeutic agents and provides foundational data for future research.

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Antineoplastics

2021

Reactions Weekly

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Drug-related pneumonia with hypersensitivity pneumonitis pattern with various other toxicities: 3 case reportsIn a retrospective study of 133 patients diagnosed with drug-related pneumonitis (DRP) between October 2013 and October 2019, three patients including two men and one woman aged 51-77 years were described who developed DRP with hypersensitivity pneumonitis (HP) pattern during treatment with paclitaxel, everolimus or nivolumab. Additionally, one patients developed lower limb pain, renal failure or lack of efficacy during treatment with capecitabine, oxaliplatin, trastuzumab, nivolumab, cisplatin, vinorelbine, carboplatin or paclitaxel [routes not stated; not all dosages, duration of treatments to reactions onset and outcomes stated].Case 1: A 77-year-old man developed DRP with hypersensitivity pneumonitis (HP) pattern during treatment with paclitaxel for metastatic advanced gastric cancer. Additionally, he developed lower limb pain during treatment with capecitabine, oxaliplatin and trastuzumab and renal failure during treatment with nivolumab. The man, who had smoking history and no recent history of exposure to dust, started receiving first-line chemotherapy with capecitabine, oxaliplatin and trastuzumab. He had been receiving various regular home medications. However, he developed chemotherapy-related lower limb pain. After four cycles, he developed prolonged nausea and fatigue [aetiologies not stated]. He had progression of gastric cancer and gastric dilation with gastric outlet obstruction requiring laparoscopic gastrojejunostomy. He was discharged 2 weeks after surgery. He was started on unspecified antipyretic and analgesic drug for fever, postoperative pain and lower limb pain. Thereafter, he started receiving second-line therapy with nano albumin-bound (nab)-paclitaxel and ramucirumab. On day 8 after the first cycle, paclitaxel was interrupted due to neutropenia [aetiology not stated]. On day 18, he had a high-grade fever and malaise. Therefore, he was treated with levofloxacin. On day 22, a chest CT scan revealed an abnormal shadow in the lung fields. He was referred to current facility. On admission, a peripheral blood test revealed elevated CRP and decreased arterial partial pressure of oxygen (PaO2). A repeat chest CT scan suggested a non-fibrotic typical HP pattern. A bronchoalveolar lavage (BAL) revealed increased lymphocyte count. Culture of BAL fluid yielded negative infectious aetiologies. A transbronchial lung biopsy (TBLB) revealed fibro-cellular alveolitis and accumulation of histiocytes without granulomas. He was diagnosed as grade 2 DRP with radiographic HP pattern, probably due to paclitaxel, after excluding other possible causes. The score on Naranjo causality assessment scale was 5 indicating probable association between paclitaxel and DRP with HP pattern. Chemotherapy was discontinued, and his condition was carefully monitored. On day 33 of the admission, he was treated with pulse methylprednisolone for 3 days. His fever and abnormal shadow improved, without maintenance of steroi...

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Drug-related pneumonitis with radiographic hypersensitivity pneumonitis pattern: Three case series

Cited by 3 publications

References 40 publications

Serum Biomarkers in a Radiological Pattern of Non-Fibrotic Hypersensitivity Pneumonitis: Implications for Mechanistic Difference and Differential Diagnosis

Serum Biomarkers in a Radiological Pattern of Non-Fibrotic Hypersensitivity Pneumonitis: Implications for Mechanistic Difference and Differential Diagnosis

Incidence and Clinical Characteristics of Drug-Induced Lung Disease Among Chemotherapy Recipients

Antineoplastics

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