Osimertinib-Induced Unilateral Diffuse Alveolar Hemorrhage in a Patient With Pulmonary Adenocarcinoma

Abstract

A 70-year-old man with lung adenocarcinoma was admitted to our hospital due to progressive dyspnea, 4 months after osimertinib initiation. His chest radiograph and computed tomography revealed ground-glass opacities and consolidations dominantly in the upper left lung. He took neither antiplatelet nor anticoagulation agent. No abnormality in coagulation was detected. Bronchoalveolar lavage fluid (BALF) became serially and increasingly hemorrhagic, and confirmed the diagnosis of alveolar hemorrhage. After steroid pulse therapy and withdrawal of osimertinib, his condition gradually improved, accompanied by regression of ground-glass opacities and consolidations. Osimertinib causes not only interstitial pneumonia but also alveolar hemorrhage. The consolidations may spread not bilaterally, but be localized unilaterally. We have to keep this rare adverse event in mind, and consider immediate withdrawal of osimertinib and treatment with steroid. Increased lymphocytes in the BALF may be a potential indicator of sensitivity to steroid and favorable prognosis in diffuse alveolar hemorrhage.

Nodule‐type pneumonitis mimicking lung abscess or tumor recurrence on chest computed tomography identified as osimertinib‐induced pneumonitis: A case report

“…Osimertinib‐induced pneumonitis, an adverse event, is rarely serious or fatal. Previous studies have reported GGO‐type pneumonitis, and a case study has discussed small nodule‐type pneumonitis 2–5 . However, there are no reports of nodule‐type pneumonitis mimicking lung abscess or tumor recurrence on chest CT scan, identified as osimertinib‐induced lung pneumonitis.…”

“…Previous studies have reported GGO‐type pneumonitis, and a case study has discussed small nodule‐type pneumonitis. 2 , 3 , 4 , 5 However, there are no reports of nodule‐type pneumonitis mimicking lung abscess or tumor recurrence on chest CT scan, identified as osimertinib‐induced lung pneumonitis. Interestingly, osimertinib rechallenge by administering both osimertinib and low‐dose prednisolone was successful.…”

“…The incidence of osimertinib‐induced pneumonitis, a DILD, is 4% 1 . Various manifestations of osimertinib‐induced pneumonitis have been reported 2–5 . However, to the best of our knowledge, nodule‐type pneumonitis mimicking lung abscess or tumor recurrence on chest computed tomography (CT) scan has not previously been reported.…”

“… 1 Various manifestations of osimertinib‐induced pneumonitis have been reported. 2 , 3 , 4 , 5 However, to the best of our knowledge, nodule‐type pneumonitis mimicking lung abscess or tumor recurrence on chest computed tomography (CT) scan has not previously been reported. Here, we report a case of DILD caused by osimertinib in which a nodule pattern was observed on chest CT scan.…”

Colonic mucosal diffuse congestion associated with Osimertinib

“…However, to date, no studies have been reported in which Osimertinib was associated with gastrointestinal bleeding. [10][11][12] The only drugs used for gastrointestinal bleeding associated with EGFR-TKI were Erlotinib and gefitinib. 13 Here we report a case of advanced NSCLC with diffuse colonic mucosal bleeding detected by colonoscopy after 1.5 years of Osimertinib treatment.…”