Dasatinib
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Dasatinib Various respiratory disorders and Pseudomonas aeruginosa infection: case report
A 75-year-old man developed Pneumocystis jirovecii pneumonia (PCP), pneumonitis, pleural effusion and Pseudomonas aeruginosa infection leading to severe respiratory distress and severe respiratory failure during treatment with dasatinib for chronic myeloid leukaemia [route and times to reactions onsets not stated; not all outcomes stated]. The man, who had well-controlled chronic myeloid leukaemia (CML), hyperlipidaemia and hypertension, presented to an emergency department with progressively worsening shortness of breath and haemoptysis of 1 week. He was diagnosed with CML 2 years ago, and had been successfully treated with dasatinib 140 mg/day since then. Initial vital signs showed blood pressure, heart rate, respiratory rate, oxygen saturation and body temperature of 118/59mm Hg, 92 beats per minute, 28 breaths per minute, 87% on room air and 36.8°C, respectively. Physical exam showed that he was in mild acute distress, with decreased breath sounds over the right base and rhonchi diffusely. Chest radiograph demonstrated diffuse bilateral opacities, with greater in the left than the right. A subsequent CT scan of the chest revealed diffuse ground-glass opacity, with superimposed interlobular septal thickening and intralobular lines, which indicated crazy-paving pattern mainly in the left lower lobe and bilateral upper lobes. Also, air space disease was observed with air bronchograms adjacent to a moderate right pleural effusion. He had severe respiratory failure. Therefore, the man was admitted to the ICU for respiratory support with high flow nasal cannula. He underwent therapeutic thoracentesis, which yielded 1.8L of clear yellow, lymphocyte-predominant exudative pleural effusion. He had grade IV (moderatesized) pleural effusion with typical characteristics of dasatinib-associated effusion (exudative, lymphocyte predominant). Subsequently, the respiratory status improved. Due to the immunosuppressed state from CML and dasatinib therapy, he underwent extensive workup, and tested positive for Pseudomonas aeruginosa and Pneumocystis jirovecii PCR from induced sputum. Therefore, he started receiving empiric antibiotic therapy with piperacillin/tazobactam, cotrimoxazole [trimethoprimsulfamethoxazole] and vancomycin. Dasatinib was discontinued due to the possibility of dasatinib-induced pneumonitis and pleural effusion. His respiratory status gradually improved. He was discharged on day 12, and was followed-up as an outpatient. He completed the course of atovaquone for PCP treatment. A repeat CT scan in 1 month revealed residual small right pleural effusion along with improvement of the overall crazy paving pattern. Hamahata NT, et al. A case of severe respiratory distress in a patient with chronic myeloid leukemia receiving dasatinib. Critical Care and Shock 23: 254-259, No. 5, Oct 2020. Available from: URL: https://criticalcareshock.org/2020/10/a-case-of-severe-respiratory-distress-in-a-patient-with-chronic-myeloid-leuke
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