Temozolomide
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Alveolar-interstitial pneumonia: case report A 56-year-old woman developed alveolar-interstitial pneumonia during treatment with temozolomide for glioblastoma. Following surgery, the woman was prescribed Stupp’s protocol, consisting of temozolomide [Temodal] and radiotherapy, followed by maintenance temozolomide, in addition to methylprednisolone. From 12 Feb to 26 Mar 2007, she received 60 grays plus temozolomide 120 mg/day. On 3 May, a neurological examination was stable, but pulmonary auscultation revealed crepitation in both bases. On this day, she started maintenance therapy with temozolomide 225 mg/day as a 5-day course each month, and methylprednisolone was decreased. A few days later, she developed stage II dyspnoea. A chest x-ray showed an interstitial syndrome with left predominance. Amoxicillin/clavulanic-acid was ineffective, and the woman was referred on 29 May. A previous 3-day episode of fever was noted. Examination showed crepitant rales of both pulmonary bases with left predominance and stable left arm paresis, and a temperature of 38°C. A chest x-ray revealed an increase in bilateral interstitial syndrome associated with alveolar condensation in the left base. Investigations revealed the following: leucocytes 8.6 G/L with 95% polymorphonuclear neutrophils, lymphocytopenia (0.32 G/L), pH 7.57, PO2 87mm Hg, PCO2 29mm Hg and bicarbonate 27 mmol/L. Tomodensitometry revealed alveolar-interstitial opacities with basal predominance, associated with the start of foci of parenchymatous condensation. There was an anterior pericardial effusion with a pericardium measuring a maximum of 8mm. Bronchoalveolar lavage showed a cell count of 0.91 × 109/L with lymphocytosis,
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