Dasatinib
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COVID-19 pneuminia, febrile neutropenia, pancytopenia and pleural effusion: case report A 65-year-old man developed febrile neutropenia, COVID-19, pancytopenia and pleural effusion during treatment with dasatinib for accelerated phase chronic myelogenous leukaemia (AP-CML) [route, frequency and duration of treatment to reactions onset not stated; not all outcomes stated]. The man, who had a 4-year history of AP-CML, presented to the emergency department with progressive shortness of breath with exertion and a 3-day history of febrile sensation. He also had productive cough with a small amount of yellowish sputum and experienced intermittent pleuritic chest pain for few days. He had been receiving dasatinib 140mg for AP-CML. His dasatinib dose was reduced to 100mg due to pancytopenia, which resolved after adjusting the dose [route not stated]. He also had dasatinibrelated chronic right-sided small loculated pleural effusion. On presentation, he was febrile with temperature of 38.4°C. His oxygen saturation (SpO2) was 94% on 6L via a nonrebreather mask, RR was 19 breath/minute, HR was 104 beats/minute and BP was 138/79mm Hg. His breath sounds were decreased on the bilateral lower lung fields along with a coarse crepitation in the middle right to lower regions. Laboratory investigations revealed pancytopenia, increased INR and PTT, and elevated D-dimer and CRP level. Chest X-ray revealed lower lobe collapse bilaterally and consolidation with pleural effusion, mostly on the left side, which had increased compared to the baseline. He tested positive for COVID-19. Chest CT scan revealed bilateral pleural effusions on the left side with lower lobe sub-segmental collapse and consolidation as a consequence along with the bilateral lower lung lobe postinflammatory changes and a likely right anterior empyema formation. He was hospitalised with neutropenic fever and COVID-19. He started receiving off-label treatment with oral hydroxychloroquine 400 mg/day, oral azithromycin 500 mg/day and oral oseltamivir 150mg twice a day for COVID-19. He also received piperacillin/tazobactam and his dasatinib therapy was suspended. Thoracocentesis was performed, 500mL was removed and a drain was inserted. Pleural fluid analysis revealed exudative lymphocytic pleural effusion and negative acid fast bacilli smears, cultures and PCR. On day 4 of hospitalisation, an improvement was noted and he was taken off oxygen. However, he became more neutropenic. On day 8, he experienced dyspnoea, tachypnoea and tachycardia, which required 10L of oxygen via the nonrebreather mask to maintain his SpO2 level above 94%. Chest auscultation revealed diffuse bilateral crackles. Arterial blood gas (ABG) showed pH of 7.48, pO2 of 63mm Hg, HCO3 of 27.4 mmol/L and pCO2 of 34mm Hg. Therefore, he received oxygen and salbutamol nebulization; however, no significant improvement was observed. Chest X-ray showed bilateral infiltrations and PaO2/FiO2 ratio was 143. He fulfilled the criteria for acute respiratory distress syndrome (ARDS) and was still neutropenic. Given
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