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Pneumonitis and pancytopenia: case report A 75-year-old woman developed pancytopenia during treatment with azacitidine and venetoclax for acute myeloid leukaemia (AML). Additionally, she developed pneumonitis during treatment with azacitidine [routes and dosages not stated; not all outcomes stated]. The woman, who had been diagnosed with AML, presented to the emergency department (ED) for hypotension, hypoxaemia and worsening haemoptysis. She had completed first cycle of chemotherapy with azacitidine and venetoclax 11 days previously. After completing a 7-day cycle of venetoclax and azacitidine, her shortness of breath had progressed to the point where she was short of breath at rest. Vital signs in the ED showed hypotension, tachycardia, saturating 90% on room air. Laboratory findings showed pancytopenia with haemoglobin 46 g/L, mean corpuscular volume 91.4FL, WBC 0.4 × 109/L, and platelet count of 15 × 109/L, increased lactic acid of 2.7 mMol/L. Chest X-ray revealed severe airspace disease. Subsequently, she was admitted to the ICU and started on treatment with vancomycin, fluconazole, cefepime, azithromycin and aciclovir for presumed sepsis secondary to community acquired pneumonia versus cytomegalovirus (CMV) pneumonitis. Also, she received two units of blood for symptomatic normocytic anaemia but continued to have haemoptysis. Her oxygen requirement raised as she needed 10L of highflow nasal cannula to maintain a saturation above 90%. Additionally, CT imaging of the chest showed ground glass/consolidative changes throughout the lungs involving all lobes with primary central distribution and small bilateral pleural effusions. Bronchoscopy showed right and left lower lobe mucosa thickening and friability. Furthermore, vancomycin was discontinued as cultures were negative for methicillin-resistant Staphylococcus aureus, but she continued on cefepime, and completed 5 day course of azithromycin, aciclovir and fluconazole. Although she was treated with antibiotics, antiviral and antifungal agents, her respiratory status did not improve; thus, she was initiated on high dose glucocorticoid therapy for presumed pneumonitis secondary to azacitidine. Within 2–3 days of initiating prednisone 30mg two times a day, the woman’s oxygen requirements improved; it confirmed the diagnosis of azacitidine-induced pneumonitis. Additionally, she was also diagnosed with pancytopenia secondary to chemotherapy (azacitidine and venetoclax). She was discharged to a subacute rehab facility to recondition herself and to complete a total of 5 weeks of prednisone with taper. On follow-up at 2 month, she was doing much better and no longer requirement of supplemental oxygen. Her repeat chest CT revealed significant interval improvement in previously demonstrated extensive consolidative changes with residual ground glass changes. Nguyen P, et al. Azacitidine-induced pneumonitis and literature review. BMJ Case Reports 13: e236349, No. 10, 29 Oct 2020. Available from: URL: http://doi.org/10.1136/ 803518867 bcr-2020-236349

0114-9954/20/1833-