Gemcitabine/paclitaxel

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Gemcitabine/paclitaxel Hypersensitivity pneumonitis: case report

An approximately 78-year-old man developed hypersensitivity pneumonitis during treatment with gemcitabine and paclitaxel for metastatic malignant schwannoma. The man, who had undergone localised excisions, was diagnosed with recurrent malignant schwannoma in 2002, at the age of 74 years. In August 2006, a CT scan showed bilateral lung metastases. Hence, he underwent partial lung resection and segmentectomy. Histopathological examination of the resected lesion showed metastatic malignant schwannoma. Therefore, he started receiving chemotherapy with gemcitabine 1000 mg/m2 and paclitaxel 80 mg/m2 on days 1, 8 and 15 of a 28 cycle [routes not stated]. He received 4 cycles of the chemotherapy in 16 weeks. After the 3rd day of fourth chemotherapy cycle, he reported shortness of breath. Hence, high-resolution CT scan was performed that demonstrated patchy ground-glass attenuation bilaterally, along with fine peripheral reticular interstitial opacities. Further investigation ruled out infection and an echocardiograph showed normal ejection fraction. However, increased level of blood CA 15-3 was noted. Based on these findings, he was diagnosed with hypersensitivity pneumonitis related to the chemotherapy. Therefore, the man was shifted to the ICU and treated with methylprednisolone. He also received bilevel positive airway pressure support due to 84% oxygen saturation. Thereafter, his dyspnea improved and nasal oxygen support was continued for 8 additional days. Eventually, he was discharged from hospital on day 10 after the onset of the condition. A repeated CT scan and chest X-ray revealed resolution of ground glass opacities. However, progressive reticular lesions were noted. His high-resolution CT imaging showed architectural distortion and traction bronchiectasis secondary to interstitial fibrosis. His CA 15-3 levels normalised within 4 weeks. Comlek S. Chemotherapy-induced pneumonitis associated with transient CA 15-3 elevation. Journal of Oncology Pharmacy Practice 26: 1750-1753, No. 7, Oct 2020. Available from: URL: http://doi.org/10.1177/1078155220904994

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Reactions 5 Dec 2020 No. 1833

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