Hypersensitivity pneumonitis related to imatinib mesylate therapy in a patient with chronic myeloid leukemia

Abstract

Introduction Pulmonary toxicity causally related to Imatinib (IM) therapy is uncommon in patients with chronic myeloid leukemia. Case report A 61-year-old patient with chronic myeloid leukemia was treated with IM at 400 mg daily dose. One month within IM, he developed skin lesions and then acute dyspnea and non-productive cough. Chest radiograph and high-resolution lung computed tomography (CT) revealed bilateral reticulonodular infiltration in both lungs. According to Naranjo's algorithm, the causality relationship with the drug is probable with a score of 7. The pharmacovigilance investigation was carried out and implicated IM Management & outcome: IM was discontinued and started steroid therapy (Prednisolone®) at 1 mg/kg daily. Two weeks after, the dyspnea, and abnormal X-ray and CT findings are improved. Discussion The early diagnosis of pulmonary toxicity related to IM therapy is needed to avoid further determinal effects of the drug.

Bilateral intracochlear hemorrhage: A rare onset of chronic myelogenous leukemia

“…Imatinib is in general well tolerated by patients and adverse events can be divided into hematological (anemia, neutropenia, thrombocytopenia) vs nonhematological (cardiovascular, pancreatic, hepatic, cutaneous, gastrointestinal effects; fluid retention, bleeding, musculoskeletal disorders, neuropathy, ocular toxicity, infectious, or metabolic events). Cases with pneumonitis and pulmonary interstitial fibrosis like in the case here described have been reported previously 3–5 but rarely outside Asia 6,7 . Several authors have reported on succesful outcome of pulmonary adverse events upon discontinuation of imatinib in combination with initiation of corticosteroid treatment 3–7 .…”

“…Cases with pneumonitis and pulmonary interstitial fibrosis like in the case here described have been reported previously [3][4][5] but rarely outside Asia. 6,7 Several authors have reported on succesful outcome of pulmonary adverse events upon discontinuation of imatinib in combination with initiation of corticosteroid treatment. [3][4][5][6][7] Ohnishi et al however reported on 27 patients with Imatinib-induced interstitial lung disease.…”

“…6,7 Several authors have reported on succesful outcome of pulmonary adverse events upon discontinuation of imatinib in combination with initiation of corticosteroid treatment. [3][4][5][6][7] Ohnishi et al however reported on 27 patients with Imatinib-induced interstitial lung disease. 4 Imatinib was discontinuated in all the reported cases and 24 cases were treated with corticosteroids, however, four patients failed to improve and one patient suffered from pulmonary fibrosis despite highdose corticosteroid treatment.…”

“…CML is nowadays successfully treated with tyrosine kinase inhibitors (TKIs) and the medication is generally well tolerated by the patients. Rare pulmonary complications have however been described, but seldom outside Asia 3–7 . We here present an unusual case with bilateral intracochlear hemorrhage at onset of CML, with the rare complication of pneumonitis, and lung fibrosis secondary to treatment with the TKI Imatinib.…”

“…Rare pulmonary complications have however been described, but seldom outside Asia. [3][4][5][6][7] We here present an unusual case with bilateral intracochlear hemorrhage at onset of CML, with the rare complication of pneumonitis, and lung fibrosis secondary to treatment with the TKI Imatinib. The hearing loss secondary to the intracochlear hemorrhage is often permanent but, in this case, one side improved over 6 months.…”