Palbociclib
- PDF / 172,099 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 2 Downloads / 181 Views
1 S
Interstitial pneumonitis: case report An 89-year-old woman developed interstitial pneumonitis during treatment with palbociclib for metastatic breast cancer. The woman had undergone radiofrequency ablation and letrozole treatment for right breast cancer. Eight years later, she was suspected of having bone metastases. A local recurrence of breast cancer and multiple bone metastases were diagnosed. Her medical history included Herpes zoster and family history was unremarkable. Her regular medications included chondroitin sulfate [chondroitin], glucosamine and ascorbic acid [vitamin C]. She was found to have invasive ductal carcinoma. She received treatment with tamoxifen. Her condition progressed and her treatment with switched to palbociclib [route and dosage not stated] and fulvestrant. She developed peripheral facial nerve palsy [aetiology unknown]. She started receiving famotidine for ulcer prevention and valaciclovir for the prevention of recurrence of shingles. Her treatment with palbociclib was temporarily discontinued. She responded well to unspecified steroids, so the dose was decreased. However, she developed fever, followed by respiratory distress. She presented to the emergency department and was admitted immediately due to acute respiratory failure. On admission, examination showed body temperature 39.4°C, BP 130/76mm Hg, pulse rate 94 /min, SpO2 80% (room air), rapid breathing and pulmonary murmur auscultation in both lungs. Blood test showed WBC 8200 /µL (85.3% neutrophils, 7.4% lymphocytes, 1.0% eosinophils), C-reactive protein 13 mg/dL, AST 68 U/L, ALT 35 U/L, LDH 812 U/L, Krebs von den Lungen‐6 (KL-6) >7000 U/mL, serum surfactant protein D (SP-D) 895 ng/mL. Blood gas analysis showed pH 7.490, pCO2 28.0mm Hg and pO2 61.8mm Hg. Chest CT showed patchy ground-glass opacities spread extensively in both lungs. Infectious disease screening was negative for gastric fluid fast bacilli PCR, sputum stain, sputum DNA-PCR and serum Cryptococcus antigen, pharyngeal mycoplasma antigen. The serum beta-D-glucan level was 7.1 (20.0 pg/mL). Thus, based on the CT scan findings, Pneumocystis pneumonia was suspected. The woman started receiving treatment with unspecified ST compounds, piperacillin/tazobactam [tazobactam/piperacillin] and prednisolone. Thereafter, her oxygenation worsened, and non-invasive positive pressure ventilation (NIPPV) was installed. Subsequently, she was found to be negative for all of the infectious diseases at the time of admission and her KL-6 and SP-D were high. Thus, it was concluded to be drug-induced lung damage (interstitial pneumonitis) caused by palbociclib [duration of treatment to reaction onset not stated]. Steroid pulse therapy with methylprednisone was started and maintained with prednisone. Her respiratory status improved. Thus, she was weaned off the NIPPV, and the ground-glass opacities improved on CT scan. Thereafter, the steroid does was tapered-off. However, her respiratory status worsened, and ground glass opacities were noted on CT scan. She received a second ste
Data Loading...
