Durvalumab
- PDF / 170,721 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 47 Downloads / 122 Views
1 S
Diffuse alveolar haemorrhage: case report A 76-year-old man developed diffuse alveolar haemorrhage during treatment with durvalumab for squamous cell carcinoma of the lung. The man, who had squamous cell carcinoma of the lung, started on radiotherapy and chemotherapy comprising carboplatin and paclitaxel weekly. He had been receiving edoxaban regularly for atrial fibrillation. Following 9 days of end of thoracic radiation, he developed fever. Further examination showed suspected radiation pneumonitis. Then he was started on prednisolone, which was gradually reduced and eventually discontinued. When the dose of prednisolone was reduced the maintenance therapy with durvalumab 10 mg/kg bi-weekly was initiated [route not stated]. Following 11 cycles of durvalumab and 3 weeks after prednisolone discontinuation, he developed dyspnea and malaise. His vital signs were as follows: body temperature 37.3oC, heart rate 75 beats per minute, blood pressure 111/81mm Hg, and oxygen saturation 96% at room air. Chest Ct revealed new ground glass opacities (GGOs) in the bilateral lower lobes that was extending beyond the irradiated areas. Laboratory investigations revealed increase in CRP and KL-6. Therefore, he was hospitalized and underwent fiberoptic bronchoscopy on day-2 of admission. The bronchoalveolar lavage fluid from the right B8 became bloody and showed a cell count of 13.4 x 105 cells/mL with neutrophils 70%, lymphocytes 10.5%, eosinophils 11% and macrophages 8.5%. In spite of immediate discontinuation of edoxaban and initiation of ciprofloxacin, his symptoms and respiratory conditions were found to be deteriorated rapidly. Despite bacterial culture of bronchoalveolar lavage fluid (BALF) was found to be negative, a hemosiderin-laden macrophages was detected. Based on these findings, a diagnosis of diffuse alveolar haemorrhage was made [duration of treatment to reaction onset not stated]. On day-7 of admission, the man was started on prednisolone. A chest CT revealed an expansion of GGOs to the left lung. Subsequently, methylprednisolone pulse was initiated for 3 days. On day-14 of admission, he was placed on an invasive mechanical ventilation with endotracheal intubation. On the next day, he received cyclophosphamide. On day-24, both BALF from B5 and B9 were found to be bloody and contained hemosiderin-laden macrophages. On day-50, he died due to exacerbated respiratory failure. An autopsy was performed and the findings suggested bleeding. Kanaoka K, et al. Durvalumab-Induced Diffuse Alveolar Hemorrhage: An Autopsy Case Report. Case Reports in Oncology 13: 696-701, No. 2, 22 Jan 2020. Available from: 803518604 URL: http://doi.org/10.1159/000507848
0114-9954/20/1833-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 5 Dec 2020 No. 1833
Data Loading...
