Procarbazine‐induced interstitial pneumonitis with a normal chest X‐ray: A case report

Abstract

Pulmonary toxicity due to cytotoxic drugs is well described in the literature. This is most commonly described in association with bleomycin, busulfan, and methotrexate. This report presents a case of interstitial pneumonitis with a normal chest x-ray that is most certainly due to procarbazine. In addition, the role of gallium-67 citrate scintigraphy in early diagnosis is discussed. This is especially important since discontinuation of the drug before radiographic manifestations of pulmonary toxicity become evident may prevent permanent pulmonary injury and its sequelae.

Hypersensitivity to Procarbazine and Severe RSV Pneumonia in a Child with Hodgkin’s Lymphoma

“…While these reactions are well known side effects for some certain chemotherapeutics, procarbazine related hypersensitivity reactions including fever, skin reactions, and pulmonary reactions have been reported uncommonly. [1][2][3][4][5][6][7][8][9][10][11][12][13] Procarbazine is effectively used in combination chemotherapy regimens for treatment of HL.…”

“…1,2 Hypersensitivity reactions due to procarbazine have been reported rarely during childhood. [6][7][8] Coyle et. al.…”

“…2 While pulmonary hypersensitivity is a well recognised toxicity of several anticancer drugs, particularly bleomycin, busulfan, methotrexate, and carmustine; procarbazine related pulmonary toxicity has been only rarely reported. 2,3,[8][9][10][11][12][13] Acute or delayed serious, even life-treating, pulmonary toxicity due to procarbazine can occur and may lead to reversible or permanent pulmonary damage. 2,3,[8][9][10][11][12][13] Delayed life threating pneumonitis due to rechallange with procarbazine in patients who initially had skin hypersensitivity reactions to procarbazine had been reported.…”

“…2,11 Previously, severe pulmonary toxicity was reported in case procarbazine was continued after the development of skin hypersensitivity. 2,8,9 In patients who develop pulmonary infiltrations while receiving procarbazine, procarbazine related pulmonary hypersensitivity should be considered in differential diagnosis. It should be kept in mind that procarbazine related hypersensitivity and subsequent pulmonary toxicity can be a life treating condition.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] Hypersensitivity to procarbazine is particularly uncommon during childhood. [6][7][8] Here we report on a child with Hodgkin's lymphoma (HL) who developed procarbazine induced skin hypersensitivity reactions, and then severe pneumonia due to the respiratory syncytial virus (RSV) while receiving procarbazine, and bleomycin containing chemotherapy.…”