Cidofovir
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Cidofovir Various toxicities and compassionate use: 2 case reports
In a report, a 3-year-old girl and an 8-year-old girl were described, who developed haemoptysis, desaturation or bronchiolitis obliterans organising pneumonia during compassionate use of nebulised cidofovir for recurrent laryngeal papillomatosis (RLP). Case 1: A 3-year-old girl, who had a history of orotracheal intubation and prematurity at birth, was diagnosed with RLP due to human papillomavirus (HPV)-6 at the age of 9 months. Three months after the diagnosis, she underwent a tracheostomy. After the diagnosis, she underwent monthly surgical interventions for resection of the lesions, and also received adjuvant therapy with interferon-α, intralesional cidofovir, indole-3-carbinol [3-indolcarbinol] and human-papillomavirus vaccine recombinant quadrivalent Merck [Gardasil]. At the age of 3 years, a papillomatous injury was observed in the right main bronchus during fibrobronchoscopy. She was stared on compassionate treatment with nebulised cidofovir 4mL (concentration of 10 mg/mL) three times per week. After the fifth dose of nebulised cidofovir, she presented with frank haemoptysis and desaturation. Hence, she was hospitalised to control symptomatology. Nebulised cidofovir therapy was stopped, following which she had no more bleeding episodes. Case 2: An 8-year-old girl, who was diagnosed with RLP due to human papillomavirus (HPV)-11 at the age of 18 months, required tracheostomy to maintain airway permeability. Since the diagnosis of RLP, she underwent bi-monthly or monthly surgeries, and has been treated with systemic or intralesional cidofovir, interferon-α and human-papillomavirus vaccine recombinant quadrivalent Merck [Gardasil]. At the age of 8 years, she presented with progressive respiratory distress, and fibrobronchoscopy showed papillomatous lesions in the trachea. She was started on compassionate treatment with nebulised cidofovir 4mL (concentration of 5 mg/mL) three times per week, following which a good clinical response was observed. Nine months after the initiation of nebulised cidofovir, she presented with hypoxaemia, constitutional syndrome and increased respiratory distress. Pulmonary highresolution CT (HRCT) showed patchy focal areas with bilateral bibasilar cylindrical bronchiectasis and ground-glass density. Based on the findings, she was diagnosed with bronchiolitis obliterans organising pneumonia. Nebulised cidofovir therapy was stopped, and she was treated with unspecified corticosteroids. Following treatment, clinical improvement was noted and oxygen withdrawal were possible. Pulmonary HRCT demonstrated radiological improvement in the cylindrical bronchiectasis and ground-glass pattern. Subsequently, unspecified corticosteroids were discontinued. Aerosol therapy and respiratory physiotherapy was continued. Sanchez-Moreno P, et al. Hemoptysis and Bronchiolitis Obliterans in Children with Recurrent Respiratory Papillomatosis: Adverse Reactions to Nebulized Cidofovir. Archivos de Bronconeumologia 55: 386-387, No. 7, Jul 2
