Doxorubicin
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Worsened interstitial lung disease and neutropenia: case report A 74-year-old man developed worsened interstitial lung disease (ILD) and grade 4 neutropenia during treatment with doxorubicin for the lung metastasis and the pleural dissemination of the retroperitoneal sarcoma. The man presented with several month’s histories of intermittent pain in the right upper abdominal quadrant and back with temporal itchy rashes in the abdomen. Further investigation suggested possible ILD and malignant retroperitoneal tumour. Therefore, he was admitted to the hospital for surgical treatment. Later, retroperitoneal tumor resection was performed and he was diagnosed with undifferentiated spindle cell sarcoma. Due to his strong desire to be discharged, he was discharged home. Two months later, his skin symptoms persisted with muscle weakness. Therefore, he was re-admitted to the hospital for further examination and treatment. He had a history of smoking 20 cigarettes a day for 35 years. His family history included a sister with rheumatic disease. Based on further investigation, he was diagnosed with an anti-synthetase syndrome with positive anti-glycyltransfer ribonucleic acid synthetase antibody (anti-EJ). Therefore, he was started on prednisolone, tacrolimus and methylprednisolone pulse therapy. Eventually, improvement in his condition was noted. However, an expanding lung metastatic lesion from primary sarcoma was detected and he continued on prednisolone and tacrolimus treatment. Subsequent investigation showed improvement in pulmonary functions. However, increased pulmonary nodule size and right pleural effusion were noted. Therefore, surgical resection was canceled and he was initiated on doxorubicin for the lung metastasis and the pleural dissemination of the retroperitoneal sarcoma [route and dosages not stated]. However, after the initiation of doxorubicin, he developed temporarily worsened ILD and grade 4 neutropenia [exact duration of treatment to reaction onset not stated]. The man’s doxorubicin treatment was discontinued and prednisolone dose was tapered. Thereafter, he underwent surgery and followed for 21 months without progression of ILD or dyspnoea using prednisolone and tacrolimus, but lesion metastasis was noted [not all outcomes not stated]. Fukui S, et al. Anti-EJ antibody-positive anti-synthetase syndrome associated with retroperitoneal sarcoma. Internal Medicine 59: 2071-2076, No. 16, 2020. Available from: 803504305 URL: http://doi.org/10.2169/internalmedicine.3923-19
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Reactions 3 Oct 2020 No. 1824
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