Bortezomib
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Diffuse alveolar haemorrhage: case report A 59-year-old woman developed diffuse alveolar haemorrhage during treatment with bortezomib for plasma cell leukaemia. The woman presented to a hospital in Canada with a four-week history of myalgia, malaise, chills and unintentional weight loss. At the same time, she also showed a non-productive cough and rhinorrhoea. Medical history showed that, she took daily supplements including vitamin D, vitamin C, zinc, garlic and a multivitamin medication. She intermittently used marijuana in the past. On further investigations, she was diagnosed with plasma cell leukaemia. On hospital day 8, she started receiving bortezomib 1.3 mg/m2 [route not stated], weekly along with dexamethasone and lenalidomide. On the next day, she showed a significant worsening of cough and her sputum contained small volumes of dark blood. On hospital day 10, severe cough and haemoptysis persisted. A chest CT scan revealed bilateral patchy ground glass opacities along with regions of crazy paving and new small bilateral pleural effusions. On hospital day 11, bronchoscopy was carried out. Sequential bronchoalveolar lavage showed increasingly haemorrhagic returns. After ruling out all other infectious aetiologies, a workup for alveolar haemorrhage was started. Her C-reactive protein level was significantly elevated with a value of 82.1 mg/L (on admission, it was 2.9 mg/L). She became clinically stable on room air without further haemoptysis after day 12 and a gradual improvement in cough was also noted. On hospital day 13 and day 14, she developed fever which triggered a delayed symptom of a bortezomib-induced reaction, hence a diagnosis of bortezomib-induced diffuse alveolar haemorrhage was made. The woman started receiving treatment with prednisone which led to a resolution of fever. On hospital day 17, a repeat chest CT scan demonstrated a near complete resolution of the ground glass opacities along with some residual mosaicism in her upper lung zones and a reduction in the size of her effusions. Thereafter, she was discharged from hospital and therapy with lenalidomide was continued and a tapering dose of dexamethasone was provided. It was advised that she should not be rechallenged with bortezomib. She did not show any relapse of her respiratory symptoms. Wirth IM, et al. Bortezomib-induced diffuse alveolar hemorrhage in a patient with plasma cell leukemia. Respiratory Medicine Case Reports 31: 2020. Available from: URL: 803497107 http://doi.org/10.1016/j.rmcr.2020.101169
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Reactions 22 Aug 2020 No. 1818
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